Evidence map›Paper›PMID 41477971›Full record

ArticleJournal of critical care2026

Derivation and validation of a prediction rule for sedative-associated delirium during acute respiratory failure requiring mechanical ventilation.

Niall T Prendergast, Chukwudi A Onyemekwu, Kelly M Toth, Christopher A Franz, Georgios D Kitsios, Bryan J McVerry, Pratik P Pandharipande, E Wesley Ely, Timothy D Girard

Abstract readValidation StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing 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

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Niall T PrendergastDivision of Pulmonary, Allergy, Critical Care, and Sleep Medicine in the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: prendergastnt@upmc.edu.
Chukwudi A OnyemekwuCenter for Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Kelly M TothCenter for Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Christopher A FranzUPMC Harrisburg, Harrisburg, PA, USA.
Georgios D KitsiosDivision of Pulmonary, Allergy, Critical Care, and Sleep Medicine in the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Bryan J McVerryCenter for Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Pratik P PandharipandeCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Anesthesiology Critical Care Medicine in the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
E Wesley ElyCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Allergy, Pulmonary, and Critical Care Medicine in the Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.
Timothy D GirardCenter for Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.

Funding

Regulation of Cardiolin Byosynthesis in Epithelial InjuryP01HL114453 · NHLBI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI MCVERRY, BRYAN J · 2014 to 2023
$21.3M
The MIND ICU StudyR01AG027472 · NIA · VANDERBILT UNIVERSITY · PI ELY, E WESLEY · 2006 to 2010
$3.0M
Microbial Determinants of Acute Respiratory Distress Syndrome Severity (MiDAS)R03HL162655 · NHLBI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI KITSIOS, GEORGIOS · 2022 to 2023
$159k
Generation and Validation of a Clinical Prediction Rule for Sedative-Associated Delirium During Acute Respiratory FailureF32HL158058 · NHLBI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI PRENDERGAST, NIALL · 2021 to 2022
$125k
NHLBI NIH HHS F32 HL158058NHLBI NIH HHS P01 HL114453NHLBI NIH HHS R03 HL162655NIA NIH HHS R01 AG027472
6 · The paper itself

Abstract

objectiveTo derive and validate a simple, transparent model that quantifies risk for sedative-associated delirium in mechanically ventilated ICU patients, which could be used to guide decisions about personalized sedation.

designWe performed backward stepwise logistic regression to derive a model predictive of sedative-associated delirium. We validated this model internally using hundredfold bootstrapping. We then validated this model externally in a separate prospective cohort of mechanically ventilated ICU patients.

settingFive US hospitals, including one academic, one private, and three veterans hospitals. PATIENTS: The parent cohort consisted of 1040 patients with either septic or cardiogenic shock, acute respiratory failure, or both. From the parent cohort 836 patients who received mechanical ventilation were selected to comprise the derivation cohort.

interventionsNone. MEASUREMENTS AND MAIN

resultsBackwards stepwise regression produced a model with age, BMI, sepsis, SOFA, malignancy, COPD, sex, and doses of opioids, propofol, and benzodiazepines as predictors of sedative-associated delirium. The model had very good discriminative power, with an area under the receiver-operator curve (AUROC) of 0.83. Internal validation via bootstrapping showed preserved discriminatory function with an AUROC of 0.81 and graphical evidence of good calibration. External validation in a separate set of 340 patients showed good discrimination, with AUROC of 0.70.

conclusionsRisk for sedative-associated delirium during acute respiratory failure requiring mechanical ventilation can be quantified using a simple, transparent model, which can now be validated in a prospective study.

Indexed as

DeliriumHypnotics and SedativesRespiration, ArtificialRespiratory InsufficiencyAgedFemaleHumansIntensive Care UnitsLogistic ModelsMaleMiddle AgedProspective StudiesRisk AssessmentRisk FactorsHypnotics and SedativesDeliriumMechanical ventilationModelingRisk predictionSedation

Identifiers

PMID41477971
PMCPMC13403210

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Registered trials

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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.