Could Greater Depth of ED Sedation Be Associated with Worse Outcome?

Authors: Stephens RJ et al., Chest 2017 Jun 29;

In a prospective study of mechanically ventilated emergency department patients, deeper sedation levels were associated with increased mortality.

Deeper sedation levels within the first 48 hours of intensive care unit admission have been associated with longer duration of mechanical ventilation and increased mortality. Unclear, however, is whether deeper levels of sedation in intubated emergency department (ED) patients has the same effects on mortality.

These authors analyzed a prospective observational cohort of 414 adult patients who were mechanically ventilated in a single ED. Patients were excluded if they were intubated for cardiac arrest or neurologic injury since they frequently have depressed mental status. Sedation depth was measured with the Richmond Agitation-Sedation Scale

Fentanyl (86% of patients), midazolam (61%), and propofol (47%) were used most often for ED sedation, followed by ketamine (16%) and etomidate (4%). Sixty patients (15%) died in the hospital (primary outcome). Deep sedation occurred in 64% of patients. In multivariable analysis adjusted for possible confounders, a deeper ED sedation level was associated with higher mortality (odds ratio, 0.77).