Evidence map›Paper›PMID 39776348›Full record

Observational studyNeurocritical care2025

Sedation Practices in Mechanically Ventilated Neurocritical Care Patients from 19 Countries: An International Cohort Study.

Shi Nan Feng, Lindsay H Laws, Camilo Diaz-Cruz, Raphael Cinotti, Marcus J Schultz, Karim Asehnoune, Robert D Stevens, Chiara Robba, Sung-Min Cho, ENIO collaborators

Erratum issuedAbstract readObservational StudyMulticenter Study
PubMed Publisher
In one paragraph

Observational study in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Shi Nan FengDivision of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Lindsay H LawsDivision of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Camilo Diaz-CruzDepartment of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Raphael CinottiDepartment of Anesthesia and Critical Care, Centre Hospitalier Universitaire de Nantes, Nantes Université, Hôtel Dieu, Nantes, France.
Marcus J SchultzDepartment of Clinical Medicine, University of Oxford Nufeld, Oxford, UK.
Karim AsehnouneDepartment of Anesthesia and Critical Care, Centre Hospitalier Universitaire de Nantes, Nantes Université, Hôtel Dieu, Nantes, France.
Robert D StevensDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
Chiara RobbaIstituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy.
Sung-Min ChoDivision of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. csungmi1@jhmi.edu.ORCID http://orcid.org/0000-0002-5132-0958
ENIO collaborators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOur objective was to characterize the impact of common initial sedation practices on invasive mechanical ventilation (IMV) duration and in-hospital outcomes in patients with acute brain injury (ABI) and to elucidate variations in practices between high-income and middle-income countries.

methodsThis was a post hoc analysis of a prospective observational data registry of neurocritically ill patients requiring IMV. The setting included 73 intensive care units (ICUs) in 18 countries, with a total of 1,450 patients with ABI requiring IMV. There were no interventions.

resultsPatients were categorized into day 1 propofol, midazolam, propofol and midazolam, dexmedetomidine, or sodium thiopental. The primary outcome was duration of IMV. Secondary outcomes were ICU and hospital mortality, ICU length of stay, days to first extubation, extubation failure, and withdrawal of life-sustaining therapy. Multivariable analyses were adjusted for clinically preselected covariates. Of 1,450 included patients (median age 54 years, 66% male), 41.2% (n = 597) were started on propofol, 26.1% (n = 379) were started on midazolam, 19.9% were started on propofol and midazolam, 0.3% (n = 5) were started on sodium thiopental, 0.7% (n = 10) were started on dexmedetomidine, and 11.8% (n = 171) were treated without sedation. After adjustment, there was no significant difference in IMV duration between patients who received midazolam (aβ = 0.64, p = 0.43, 95% confidence interval [CI] - 0.96 to 2.24) or propofol and midazolam (aβ = 0.32, p = 0.46, 95% CI - 1.44 to 2.12) compared with patients who received propofol. Patients who were started on midazolam had an average length of ICU stay that was 2.78 days longer than patients started on propofol (p = 0.003, 95% CI 0.94-4.63). There were no differences in mortality, days to first extubation, extubation failure, or withdrawal of life-sustaining therapy. Patients from high-income countries (n = 1,125) were more likely to receive propofol on day 1 (45.7 vs. 25.5%), whereas patients from middle-income countries (n = 325) were more likely to receive midazolam (32.6 vs. 24.3%) (p < 0.001).

conclusionsIn an international registry of patients with ABI requiring IMV, IMV duration did not differ significantly relative to initial sedation strategy. However, patients started on midazolam had longer ICU stay.

Indexed as

Brain InjuriesCritical CareHypnotics and SedativesOutcome Assessment, Health CareRegistriesRespiration, ArtificialAdultAgedDeveloped CountriesDexmedetomidineFemaleHospital MortalityHumansIntensive Care UnitsLength of StayMaleDexmedetomidineHypnotics and SedativesMidazolamPropofolThiopentalAcute brain injuriesCritical careMidazolamPropofolSedative

Identifiers

PMID39776348

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.