Early Deep Sedation….over-killing it is over-killing!!

This study is eloquent.

This was an observational, matched-pair analysis study. 1884 patients who were receiving mechanical ventilation in ICUs of a tertiary university hospital over six consecutive years were grouped as either lightly or deeply sedated within the first 48 hours after ICU admission. Stats are tight, but bare in mind there are still the usual cacophony of uncontrollable confounders that always haunt critical care / ill patient studies.

See pdf here

Lessons:

This emphasises the need to focus on not overkilling sedation! It is more than easy to worry about the difficult, agitated patient, or the one who seems more difficult to ventilate unless deeply sedated / paralysed. But if we do need to ‘flatten’, we need to limit it to the short-term only.

See what you think and feel free to comment.

Messages:

  • Early deep sedation is a predictor for short- and long-term mortality
  • Early deep sedation can be defined as more than 85% of RASS values ≤ −3 during the first 48 hours of ICU treatment as this reveals best diagnostic validity.
  • What are the UK incidences of early, deep sedation?? Would be interesting to know.

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