Early deep sedation is associated with decreased in-hospital and two-year follow-up survival

IntroductionThere is increasing evidence that deep sedation is detrimental to critically ill patients. The aim of this study was to examine effects of deep sedation during the early period after ICU admission on short- and long-term survival.MethodsIn this observational, matched-pair analysis, patients receiving mechanical ventilation that were admitted to ICUs of a tertiary university hospital in six consecutive years were grouped as either lightly or deeply sedated within the first 48 hours after ICU admission. The Richmond Agitation-Sedation Score (RASS) was used to assess sedation depth (light sedation: −2 to 0; deep: −3 or below). Multivariate Cox regression was conducted to investigate the impact of early deep sedation within the first 48 hours of admission on in-hospital and two-year follow-up survival.ResultsIn total, 1,884 patients met inclusion criteria out of which 27.2% (n = 513) were deeply sedated. Deeply sedated patients had longer ventilation times, increased length of stay and higher rates of mortality. Early deep sedation was associated with a hazard ratio of 1.661 (95% CI: 1.074 to 2.567; P = 0.022) for in-hospital survival and 1.866 (95% CI: 1.351 to 2.576; P <0.001) for two-year follow-up survival.ConclusionsEarly deep sedation during the first 48 hours of intensive care treatment was associated with decreased in-hospital and two-year follow-up survival. Since early deep sedation is a modifiable risk factor, this data shows an urgent need for prospective clinical trials focusing on light sedation in the early phase of ICU treatment.

• Publication year

  2015

• Venue

  Critical Care

• Publication date

  2015-04-28

• Fields of study

  Medicine

• Identifiers
  DOI 10.1186/s13054-015-0929-2PMID 25928417PMCID 4435917
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Delirium, Sedation and Analgesia in the Intensive Care Unit: A Multinational, Two-Part Survey among Intensivists

  2014cited by this paper
• R: A language and environment for statistical computing.

  2014cited by this paper
• Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

  2014cited by this paper
• Propofol is associated with favorable outcomes compared with benzodiazepines in ventilated intensive care unit patients.

  2014cited by this paper
• Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study

  2013cited by this paper
• Reducing Deep Sedation and Delirium in Acute Lung Injury Patients: A Quality Improvement Project*

  2013cited by this paper
• Pre- and post-intervention study to assess the impact of a sedation protocol in critically ill surgical patients.

  2013cited by this paper
• Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit

  2013cited by this paper
• SOPs in Intensivmedizin und Notfallmedizin: Alle relevanten Standards und Techniken für die Klinik

  2013cited by this paper
• Early Goal-Directed Sedation Versus Standard Sedation in Mechanically Ventilated Critically Ill Patients: A Pilot Study*

  2013cited by this paper
• Implementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: a randomized clinical trial.

  2013cited by this paper
• Early intensive care sedation predicts long-term mortality in ventilated critically ill patients.

  2012cited by this paper
• Sedation and analgesia in the mechanically ventilated patient.

  2012cited by this paper
• A Protocol of No Sedation for Critically Ill Patients Receiving Mechanical Ventilation: A Randomised Trial

  2011cited by this paper
• Current sedation practices: lessons learned from international surveys.

  2011cited by this paper
• An Electronic Tool for Visual Feedback to Monitor the Adherence to Quality Indicators in Intensive Care Medicine

  2011cited by this paper
• Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care – short version

  2010influential reference
• Protocolized Intensive Care Unit Management of Analgesia, Sedation, and Delirium Improves Analgesia and Subsyndromal Delirium Rates

  2010cited by this paper
• A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial.

  2010cited by this paper
• The incidence of sub-optimal sedation in the ICU: a systematic review

  2009cited by this paper
• Protocolized and target-based sedation and analgesia in the ICU.

  2009cited by this paper
• Current sedation practices: lessons learned from international surveys.

  2009cited by this paper
• Sédation-analgésie en réanimation (nouveau-né exclu)

  2008cited by this paper
• [Sedation and analgesia in intensive care (with the exception of new-born babies). French Society of Anesthesia and Resuscitation. French-speaking Resuscitation Society].

  2008cited by this paper
• Sedation and Delirium in the Intensive Care Unit: An Australian and New Zealand Perspective

  2008cited by this paper
• Sedation practice in the intensive care unit: a UK national survey

  2008cited by this paper
• Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial.

  2008cited by this paper
• Changes in sedation management in German intensive care units between 2002 and 2006: a national follow-up survey

  2007cited by this paper
• Optimal Full Matching and Related Designs via Network Flows

  2006cited by this paper
• Estimation of the Youden Index and its Associated Cutoff Point

  2005cited by this paper
• Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult.

  2002cited by this paper
• Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)

  2001cited by this paper
• Vascular Health and Risk Management Dovepress the Pathology and Treatment of Cardiac Arrhythmias: Focus on Atrial Fibrillation

  year unknowninfluential reference

• Sedation level variability as an indicator for mortality in mechanically ventilated critically ill patients: a propensity score-weighted cohort study

  2026cites this paper
• Association between the confusion assessment method for the intensive care unit (CAM-ICU) and prolonged mechanical ventilation following major cardiac surgery.

  2026cites this paper
• Depth of anaesthesia in patients undergoing transfemoral transcatheter aortic valve implantation with ‘conscious sedation and local anaesthesia’—a secondary exploratory analysis of the randomised SOLVE-TAVI trial

  2025cites this paper
• Sedation practices in patients intubated in the emergency department compared with those in patients in the intensive care unit

  2025cites this paper
• Sedierungen vermeiden

  2025cites this paper
• Early deep sedation was associated with post-hospital one-year mortality in critically ill surgical patients: a propensity-matched retrospective cohort study

  2025influential citation
• Neuromuscular Blocking Agents and Reversal Agents Usage, and Neuromuscular Blockade Monitoring in the Intensive Care Unit – Review Article

  2025cites this paper
• Future Directions in Sedation and Analgesia.

  2025cites this paper
• Nurse-Led Sedation in ICU: Impact on Clinical Outcomes of Mechanically Ventilated Patients - A Systematic Review and Meta-Analysis of RCTs.

  2025cites this paper
• Epidemiology of pain, delirium, psychiatric disorders, discomfort and sedation-analgesia management in the intensive care unit: a one-day nationwide study

  2025cites this paper
• A Retrospective, Single-Center Assessment of Changes in Pain, Agitation, and Delirium Management Before and During the COVID-19 Pandemic

  2025influential citation
• From Resuscitation to Rehabilitation: The Post-Intensive Care Syndrome Continuum in Sepsis Care

  2025cites this paper
• Management of Neuromuscular Blocking Agents in Critically Ill Patients with Lung Diseases

  2024cites this paper
• Antipsychotic initiation in mechanically ventilated patients in a medical intensive care unit

  2024cites this paper
• Early Deep Sedation Practices Worsened During the Pandemic Among Adult Patients Without COVID-19: A Retrospective Cohort Study.

  2024cites this paper
• Clinical prediction scores predicting weaning failure from invasive mechanical ventilation: Role and limitations

  2024cites this paper
• Early deep-to-light sedation versus continuous light sedation for ICU patients with mechanical ventilation: a cohort study.

  2024cites this paper
• Effects of dexmedetomidine versus propofol on outcomes in critically ill patients with different sedation depths: a propensity score-weighted cohort study.

  2024cites this paper
• Management of sedation during weaning from mechanical ventilation

  2024cites this paper
• Antibiotic prophylaxis reduced broad-spectrum antibiotics and length of stay in ICU patients with alcohol withdrawal induced refractory delirium tremens

  2024cites this paper
• Management of pain and sedation in the intensive care unit

  2024cites this paper
• Analgosedierung in der Intensivmedizin

  2024cites this paper
• Nana Korobi, Ya Oki: Deep Sedation and the Peri-COVID ICU.

  2024cites this paper
• Comparing BIS Monitoring vs. Clinical Assessment for Deep Sedation in the ICU: Effects on Delirium Reduction and Sedative Drug Doses - A randomized trial.

  2024cites this paper
• The Effect of Noise and Light on Sedation in Critical Care Patients. A Cross-Sectional Study of Critical Care Nurses in Three Intensive Care Units in Norway

  2024cites this paper
• Effect of level of sedation on outcomes in critically ill adult patients: a systematic review of clinical trials with meta-analysis and trial sequential analysis

  2024cites this paper
• High mortality in Brazilian intensive care units can be a problem of laws rather than a technical one: focus on sedation practices

  2023cites this paper
• Early processed electroencephalography for the monitoring of deeply sedated mechanically ventilated critically ill patients.

  2023cites this paper
• Rehabilitation of Chronic Pain in Post-Critical Care Patients. A Narrative Review

  2023cites this paper
• Enhancing European Management of Analgesia, Sedation, and Delirium: A Multinational, Prospective, Interventional Before-After Trial

  2023cites this paper
• Comparison of nasotracheal versus orotracheal intubation for sedation, assisted spontaneous breathing, mobilization, and outcome in critically ill patients: an exploratory retrospective analysis

  2023cites this paper
• Practice-Pattern Variation in Sedation of Neurotrauma Patients in the Intensive Care Unit: An International Survey

  2023cites this paper
• Longitudinal trajectories of sedation level and clinical outcomes in patients who are mechanically ventilated based on a group-based trajectory model: a prospective, multicentre, longitudinal and observational study in Korea

  2023cites this paper
• The Profile of Early Sedation Depth and Clinical Outcomes of Mechanically Ventilated Patients in Korea

  2023cites this paper
• Application of Neuromuscular Blockers in Patients with ARDS in ICU: A Retrospective Study Based on the MIMIC-III Database

  2023cites this paper
• Improving the efficiency of crossbred Pradu Hang Dam chicken production for meat consumption using cold plasma technology on eggs

  2023cites this paper
• Factors Associated With Deep Sedation Practice in Mechanically Ventilated Patients: A Post hoc Analysis of a Cross–Sectional Survey Combined With a Questionnaire for Physicians on Sedation Practices

  2022cites this paper
• Practices in sedation, analgesia, mobilization, delirium, and sleep deprivation in adult intensive care units (SAMDS-ICU): an international survey before and during the COVID-19 pandemic

  2022cites this paper
• Early sedation depth and clinical outcomes in mechanically ventilated patients: A single-center, retrospective cohort study.

  2022cites this paper
• Neuromuscular blockade in mechanically ventilated pneumonia patients with moderate to severe hypoxemia: A multicenter retrospective study

  2022cites this paper
• Sedation With Dexmedetomidine in Critically Ill Burn Patients Reduced Delirium During Weaning From Mechanical Ventilation

  2022cites this paper
• Dexmedetomidine and Propofol Sedation in Critically Ill Patients and Dose Associated 90-day Mortality: A Secondary Cohort Analysis of a Randomized Controlled Trial (SPICE-III).

  2022cites this paper
• Potenzieller Einfluss der Reizschwellenhöhe des nozizeptiven Flexorenreflex (NFRT) auf die Mortalitäts- und Delirinzidenz beim kritisch kranken Patienten: eine retrospektive Kohortenanalyse

  2022cites this paper
• Pain Assessment with the BPS and CCPOT Behavioral Pain Scales in Mechanically Ventilated Patients Requiring Analgesia and Sedation

  2022cites this paper
• The Feasibility of Implementing Targeted SEDation in Mechanically Ventilated Emergency Department Patients: The ED-SED Pilot Trial*

  2022cites this paper
• Sevoflurane in combination with esketamine is an effective sedation regimen in COVID-19 patients enabling assisted spontaneous breathing even during prone positioning

  2022cites this paper
• Development and validation of a RASS-related nomogram to predict the in-hospital mortality of neurocritical patients: a retrospective analysis based on the MIMIC-IV clinical database

  2022cites this paper
• [Analgesia for ventilation - what's new?]

  2022cites this paper
• Sedative polypharmacy mediates the effect of mechanical ventilation on delirium in critically ill COVID‐19 patients: A retrospective cohort study

  2022cites this paper
• Association of early sedation level with patient outcomes in moderate-to-severe acute respiratory distress syndrome: Propensity-score matched analysis

  2022cites this paper
• SÍNDROME PÓS-CUIDADOS INTENSIVOS NA CONTEMPORANEIDADE: CONTRIBUIÇÕES FISIOTERAPÊUTICAS

  2022cites this paper
• Sédation en réanimation

  2022cites this paper
• “Do no further harm” – Why shall we sedate unresponsive patients?

  2021cites this paper
• Part I: Anesthesia and ventilator management in critical care patients

  2021cites this paper
• A Case Report of Sedation Strategy for a Patient With Coronavirus Disease 2019 Supported by Extracorporeal Membrane Oxygenation After Cesarean Section.

  2021cites this paper
• Title : Inconsistent relationship between depth of sedation and intensive care outcome : systematic review and meta-analysis

  2021cites this paper
• Mobility Levels with Physical Rehabilitation Delivered during and after Extracorporeal Membrane Oxygenation (ECMO): A Marker of Illness Severity, or an Indication of Recovery?

  2021cites this paper
• Postoperative depth of sedation and associated outcomes in free flap transfers to the head and neck

  2021cites this paper
• Tools Are Needed to Promote Sedation Practices for Mechanically Ventilated Patients

  2021cites this paper
• Outcomes in Critically Ill Patients Sedated with Intravenous Lormetazepam or Midazolam: A Retrospective Cohort Study

  2021cites this paper
• Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counseling and treatment strategies

  2021cites this paper
• Pharmacotherapy and intensive care aspects of status epilepticus : update 2020 / 2021

  2021cites this paper
• Oversedation Zero as a tool for comfort, safety and management in the intensive care unit

  2021cites this paper
• Pharmakotherapie und intensivmedizinische Aspekte des Status epilepticus: Update 2020/2021

  2021cites this paper
• Updated Perspectives on the Management of Sleep Disorders in the Intensive Care Unit

  2021cites this paper
• Inconsistent relationship between depth of sedation and intensive care outcome: systematic review and meta-analysis

  2021cites this paper
• Prevent deterioration and long-term ventilation: intensive care following thoracic surgery

  2020cites this paper
• Prolonged Weaning: S2k Guideline Published by the German Respiratory Society

  2020cites this paper
• Role of Neuromuscular Blocking Agents in Acute Respiratory Distress Syndrome: An Updated Meta-Analysis of Randomized Controlled Trials

  2020cites this paper
• Practised sedation in mechanically ventilated patients: A survey of nurses’ perceptions

  2020cites this paper
• Factors related to memory absence and delusional memories in patients in intensive care units managed with light sedation.

  2020cites this paper
• Managing sedation in the mechanically ventilated emergency department patient: a clinical review

  2020cites this paper
• Oversedation Zero as a tool for comfort, safety and management in the intensive care unit

  2020cites this paper
• Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China

  2020cites this paper
• Long‐term prognosis related to deep sedation in refractory status Epilepticus

  2020cites this paper
• Nurse's Evaluation of a Pain Management Algorithm in Intensive Care Units.

  2020cites this paper
• Different depths of sedation versus risk of delirium in adult mechanically ventilated patients: A systematic review and meta-analysis

  2020cites this paper
• Effects of pain, sedation and delirium monitoring on clinical and economic outcome: A retrospective study

  2020cites this paper
• A quality improvement project to improve the identification and management of delirium.

  2020cites this paper
• Spezifische Therapie des akuten Lungenversagens

  2020cites this paper
• Optimal Sedation and Pain Management: A Patient- and Symptom-Oriented Paradigm

  2020cites this paper
• [Specific treatment of acute lung failure].

  2020cites this paper
• Actualización de la Declaración de consenso en medicina critica para la atención multidisciplinaria del paciente con sospecha o confirmación diagnóstica de COVID-19

  2020cites this paper
• The effects of sedation cessation within the first four hours of intensive care unit admission in mechanically ventilated critically ill patients – a quality improvement study

  2020cites this paper
• Use of BRASS in sedated critically-ill patients as a predictable mortality factor: BRASS-ICU

  2020cites this paper
• Drug Dosing in Special Populations: Obesity and Geriatrics

  2020cites this paper
• Organizational factors associated with target sedation on the first 48 h of mechanical ventilation: an analysis of checklist-ICU database

  2019cites this paper
• The effectiveness of systematic pain assessment on critically ill patient outcomes: A randomised controlled trial.

  2019cites this paper
• Nonpharmacologic and Medication Minimization Strategies for the Prevention and Treatment of ICU Delirium: A Narrative Review

  2019cites this paper
• Oversedation Zero as a tool for comfort, safety and intensive care unit.

  2019cites this paper
• Processed EEG monitoring for anesthesia and intensive care practice.

  2019cites this paper
• ICU Physicians' Perception of Patients' Tolerance Levels in Light Sedation Impacts Sedation Practice for Mechanically Ventilated Patients

  2019cites this paper
• Prevention of Intensive Care Unit-Acquired Pneumonia

  2019cites this paper
• Circulatory effects of dexmedetomidine in early sepsis: a randomised controlled experimental study

  2019cites this paper
• Implementing the Richmond Agitation-Sedation Scale in a respiratory critical care unit: a best practice implementation project.

  2019cites this paper
• Enteral versus intravenous approach for the sedation of critically ill patients: a randomized and controlled trial

  2019cites this paper
• In the ICU – delirium post cardiac arrest

  2019cites this paper
• Intensity Matched Algorithm for Comfort in Intensive Care Patients: I-MAC ICU

  2019cites this paper
• What is the Role of the ABCDEF Bundle in Patients on Extracorporeal Membrane Oxygenation?

  2019cites this paper
• Individualizing and Minimizing Sedation on Venovenous Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome Patients, a Reply.

  2019cites this paper