Chest

Chest

Volume 128, Issue 2, August 2005, Pages 496-506
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Clinical Investigations in Critical Care
Use of Sedatives and Neuromuscular Blockers in a Cohort of Patients Receiving Mechanical Ventilation

https://doi.org/10.1378/chest.128.2.496Get rights and content

Objective

To describe the use of sedatives and neuromuscular blocking agents (NMBs) and their impact in outcome in an international cohort of patients receiving mechanical ventilation

Methods

We analyzed the database of a prospective, multicenter cohort of 5,183 adult patients who received mechanical ventilation for > 12 h. We considered that a patient received a given agent when it was administered for at least 3 h in a 24-h period

Results

A total of 3,540 patients (68%; 95% confidence interval [CI], 67 to 69%) received a sedative at any time while receiving mechanical ventilation. The median number of days of use was 3 (interquartile range [IQR], 2 to 6 days). The persistent use of sedative was associated with more days of mechanical ventilation (median, 4 days [IQR, 2 to 8 days], vs 3 days [IQR, 2 to 4 days] in patients who did not receive sedatives [p < 0.001]); more weaning days (median, 2 days [IQR, 1 to 3 days], vs 2 days [IQR, 1 to 5 days] in patients who did not receive sedatives [p < 0.001]); and longer length of stay in the ICU (median, 8 days [IQR, 5 to 15 days], vs 5 days [IQR, 3 to 9 days] in patients who did not receive sedatives [p < 0.001]). Six hundred eighty-six patients (13%; 95% CI, 12 to 14%) received an NMB for at least 1 day. The median number of days of use was 2 (IQR, 1 to 4 days). The administration of an NMB was independently related with age, a normal previous functional status, main reason of mechanical ventilation (patients with ARDS received more NMBs), and with patient management (patients requiring permissive hypercapnia, prone position, high level of positive end-expiratory pressure, and high airways pressure)

Conclusions

The use of sedatives is very common, and their use is associated with a longer duration of mechanical ventilation, weaning time, and stay in the ICU. NMBs are used in 13% of the patients and are associated with longer duration of mechanical ventilation, weaning time, stay in the ICU, and higher mortality

Section snippets

Materials and Methods

We analyzed the database of a prospective, multicenter, international cohort of 5,183 adult patients who received mechanical ventilation for > 12 h at 361 ICUs in 20 countries.20 The general physiologic and clinical characteristics of these patients were previously described and reported.20 The institutional review board at each center approved the study protocol. For the purpose of this study, we collected the following information: demographic data (age, gender, simplified acute physiology

Use of Sedatives

Of the 5,183 ICU patients admitted during the study period, 3,540 patients (68%; 95% confidence interval [CI], 67 to 69%) received a sedative at any time while receiving mechanical ventilation. For these patients, the median number of days receiving a sedative was 3 days (IQR, 2 to 6 days).Figure 1 shows the daily percentage of patients who received a sedative according to the duration of ventilatory support. Since we registered information on sedation for 28 days, we were able to monitor

Discussion

The main findings of this prospective, international, multicentric, observational study are as follows: (1) 68% (3,540 of 5183 patients receiving mechanical ventilation) received a sedative at any time while receiving mechanical ventilation; (2) the persistent use of sedatives was associated with more days of mechanical ventilation, more weaning days, and longer length of stay in the ICU; (3) NMBs were used in 13% (686 of 5,183 patients); and (4) patients requiring NMB has a longer duration of

Mechanical Ventilation Study Group

Argentina: Coordinators: C. Apezteguia, F. Palizas. R. Alasino (Hospital Municipal de Urgencias, Córdoba); R. Bastianelli (Hospital Militar, Villa Revol); J. Berón (Hospital Pablo Soria, San Salvador); C. Bevilacqua (Clínica Modelo de Morón, Morón); M. Cafaro (Hospital Regional Río Gallegos, Río Gallegos); E. Capparelli (Hospital Eva Perón, San Martín); G. Cardonatti (Hospital San Isidro, San Isidro); R. Correa (Hospital Central, Mendoza); A. Díez (Hospital Provincial del Centenario, Rosario);

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    • Cited by (0)

    This study was supported by grant 98/0233 from the Fondo de Investigacion Sanitaria, Spain, Red GIRA (G03/063) and Red RESPIRA (C03/11) from Instituto de Salud Carlos III, Spain.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml)

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    Copyright © 2005 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.