282: THE IMPACT OF EARLY DEEP SEDATION IN MECHANICALLY VENTILATED PATIENTS DURING THE COVID-19 PANDEMIC

IntroductionIn mechanically ventilated patients, sedation strategies are a major determinant of outcome. The emergency department (ED) is the earliest exposure to mechanical ventilation for hundreds of thousands of patients annually in the USA. The one retrospective study that exists regarding ED sedation for mechanically ventilated patients showed a strong association between deep sedation in the ED and worse clinical outcomes. This finding suggests that the ED may be an optimal location to study the impact of early sedation on outcome, yet a lack of prospective studies represents a knowledge gap in this arena. This protocol describes a prospective observational study aimed at further characterising ED sedation practices and assessing the relationship between ED sedation and clinical outcomes. An association between ED sedation and clinical outcomes across multiple sites would suggest the need for changes in the current sedation strategies used in the ED, and provide evidence for future interventional studies in this field.Methods and analysisThis is a multicentre, prospective cohort study testing the hypothesis that deep sedation in the ED is associated with worse clinical outcomes. A cohort of over 300 mechanically ventilated ED patients will be included. The primary outcome is ventilator-free days, and secondary outcomes include hospital mortality, incidence of acute brain dysfunction and lengths of stay. Multivariable linear regression will test the hypothesis that deep sedation in the ED is associated with a decrease in ventilator-free days.Ethics and disseminationApproval of the study by the Institutional Review Board (IRB) at each participating site has been obtained prior to data collection on the first patient. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.

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The impact of cardiac dysfunction on acute respiratory distress syndrome and mortality in mechanically ventilated patients with severe sepsis and septic shock: An observational study

Journal of Critical Care ◽

10.1016/j.jcrc.2014.07.027 ◽

2015 ◽

Vol 30 (1) ◽

pp. 65-70 ◽

Cited By ~ 9

Author(s):

Brian M. Fuller ◽

Nicholas M. Mohr ◽

Thomas J. Graetz ◽

Isaac P. Lynch ◽

Matthew Dettmer ◽

...

Keyword(s):

Septic Shock ◽

Acute Respiratory Distress Syndrome ◽

Severe Sepsis ◽

Cardiac Dysfunction ◽

Distress Syndrome ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Sepsis And Septic Shock ◽

The Impact ◽

Ventilated Patients

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The impact of Bispectral Index monitoring on sedation administration in mechanically ventilated patients

Yearbook of Pulmonary Disease ◽

10.1016/s8756-3452(08)70736-9 ◽

2008 ◽

Vol 2008 ◽

pp. 322-323

Author(s):

J.A. Barker

Keyword(s):

Bispectral Index ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Bispectral Index Monitoring ◽

The Impact ◽

Ventilated Patients

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Bispectral Index Can Reliably Detect Deep Sedation in Mechanically Ventilated Patients

Anesthesia & Analgesia ◽

10.1213/ane.0000000000001786 ◽

2017 ◽

Vol 125 (1) ◽

pp. 176-183 ◽

Cited By ~ 11

Author(s):

Zhu-Heng Wang ◽

Han Chen ◽

Yan-Lin Yang ◽

Zhong-Hua Shi ◽

Qing-Hua Guo ◽

...

Keyword(s):

Bispectral Index ◽

Deep Sedation ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

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Impact of Serum Phosphate in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock

Journal of Intensive Care Medicine ◽

10.1177/0885066618762753 ◽

2018 ◽

Vol 35 (5) ◽

pp. 485-493 ◽

Cited By ~ 10

Author(s):

Christopher J. Miller ◽

Bruce A. Doepker ◽

Andrew N. Springer ◽

Matthew C. Exline ◽

Gary Phillips ◽

...

Keyword(s):

Septic Shock ◽

Mechanical Ventilation ◽

Severe Sepsis ◽

Clinical Outcomes ◽

Serum Phosphate ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Sepsis And Septic Shock ◽

The Impact ◽

Ventilated Patients

Background: Hypo- and hyperphosphatemia are common in severe sepsis and septic shock. Published outcome data in patients with phosphate derangements primarily focus on hypophosphatemia and the general critically ill population. This study aimed to determine the impact of serum phosphate on clinical outcomes in patients with severe sepsis and septic shock. Methods: A retrospective cohort analysis of adult mechanically ventilated patients with severe sepsis or septic shock was performed. Patients were randomly selected from an internal intensive care unit (ICU) database at an academic medical center in the United States and screened for inclusion and exclusion criteria. Time-weighted phosphate was calculated using all phosphate measurements obtained during ICU admission. The associations between time-weighted phosphate and duration of mechanical ventilation, 28-day mortality, and ICU and hospital length of stay were evaluated using linear or logistic regression as appropriate. Results: One-hundred ninety-seven patients were evaluated: 33 were categorized as hypophosphatemia, 123 as normophosphatemia, and 41 as hyperphosphatemia. Patients with time-weighted hyperphosphatemia had a higher Simplified Acute Physiology Score III score and incidence of septic shock. Significantly higher rates of 28-day mortality were observed among those with time-weighted phosphate levels above 3.5 mg/dL. However, both time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. For every 0.5 mg/dL increase in time-weighted phosphate referent values from 4.0 to 6.0, the duration of mechanical ventilation decreased by 8% to 26%. For every 0.5 mg/dL decrease in time-weighted phosphate referent values from 3.0 to 1.0, significant decreases in duration of mechanical ventilation ranged from 14% to 41%. Conclusion: Time-weighted hyperphosphatemia may be associated with increased mortality in mechanically ventilated patients with severe sepsis or septic shock. However, time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. Future studies should further describe the impact of hypo- and hyperphosphatemia on clinical outcomes among critically ill patients with severe sepsis or septic shock.

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