Initial sedation intensity in mechanically ventilated patients: go easy

From this study recently published in the blue journal:

Measurements and Main Results: We studied 251 patients (mean age, 61.7 ± 15.9 yr; mean Acute Physiology and Chronic Health Evaluation [APACHE] II score, 20.8 ± 7.8), with 21.1% (53) hospital and 25.8% (64) 180-day mortality. Over 2,678 study days, we completed 14,736 RASS assessments. Deep sedation occurred in 191 (76.1%) patients within 4 hours of commencing ventilation and in 171 (68%) patients at 48 hours. Delirium occurred in 111 (50.7%) patients with median (interquartile range) duration of 2 (1–4) days. After adjusting for diagnosis, age, sex, APACHE II, operative, elective, hospital type, early use of vasopressors, and dialysis, early deep sedation was an independent predictor of time to extubation (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.87–0.94; P less than 0.001), hospital death (HR, 1.11; 95% CI, 1.02–1.20; P = 0.01), and 180-day mortality (HR, 1.08; 95% CI, 1.01–1.16; P = 0.026) but not delirium occurring after 48 hours (P = 0.19).

Conclusions: Early sedation depth independently predicts delayed extubation and increased mortality, making it a potential target for interventional studies.