1090: SEDATIVES, DEEP SEDATION, AND COMA IN MECHANICALLY VENTILATED AIR TRANSPORT PATIENTS: A COHORT STUDY

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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Dexmedetomidine use and mortality in mechanically ventilated patients with severe burns: a cohort study using a national inpatient database in Japan

Burns ◽

10.1016/j.burns.2021.05.003 ◽

2021 ◽

Author(s):

Yuki Enomoto ◽

Masao Iwagami ◽

Asuka Tsuchiya ◽

Kojiro Morita ◽

Toshikazu Abe ◽

...

Keyword(s):

Cohort Study ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Severe Burns ◽

Inpatient Database ◽

Ventilated Patients

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Acute lung injury in mechanically ventilated patients with epidermal necrolysis: an exposed-unexposed retrospective cohort study

Burns & Trauma ◽

10.1093/burnst/tkaa041 ◽

2020 ◽

Vol 8 ◽

Author(s):

S Lalevée ◽

J Catano ◽

S Ingen-Housz-Oro ◽

M Surenaud ◽

J Tran Van Nhieu ◽

...

Keyword(s):

Cohort Study ◽

Acute Lung Injury ◽

Lung Injury ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

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Frequency and clinical impact of preserved bispectral index activity during deep sedation in mechanically ventilated ICU patients

Intensive Care Medicine ◽

10.1007/s00134-009-1636-8 ◽

2009 ◽

Vol 35 (12) ◽

Cited By ~ 21

Author(s):

Pierre Trouiller ◽

Pascal Fangio ◽

Catherine Paugam-Burtz ◽

Corinne Appéré-de-Vecchi ◽

Paul Merckx ◽

...

Keyword(s):

Bispectral Index ◽

Deep Sedation ◽

Clinical Impact ◽

Icu Patients ◽

Mechanically Ventilated

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Safety in intrahospital transportation: evaluation of respiratory and hemodynamic parameters. A prospective cohort study

Sao Paulo Medical Journal ◽

10.1590/s1516-31802008000600005 ◽

2008 ◽

Vol 126 (6) ◽

pp. 319-322 ◽

Cited By ~ 12

Author(s):

Bruno Franco Mazza ◽

José Luiz Gomes do Amaral ◽

Heloisa Rosseti ◽

Rosana Borges Carvalho ◽

Ana Paula Resque Senna ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Arterial Blood ◽

Before And After ◽

High Risk Situation ◽

Change In Mean ◽

Ventilated Patients

CONTEXT AND OBJECTIVE: Intrahospital transportation of mechanically ventilated patients is a high-risk situation. We aimed to determine whether transfers could be safely performed by using a transportation routine. DESIGN AND SETTING: Prospective cohort study with "before and after" evaluation. METHODS: Mechanically ventilated patients who needed transportation were included. Hemodynamic and respiratory parameters were measured before and after transportation. Statistical analysis consisted of variance analysis and paired Student's t test. Results were considered significant if P < 0.05. RESULTS: We studied 37 transfers of 26 patients (12 female) of mean age 46.6 ± 15.7. Patients with pulmonary diseases, positive end expiratory pressure > 5, FiO2 > 0.4 and vasoactive drug use comprised 42.4%, 24.3%, 21.6% and 33.0% of cases, respectively. Mean duration of transportation was 43.4 ± 18.9 minutes. Complications occurred in 32.4%. There was a significant increase in CO2 (before transportation, 29.6 ± 7.3 and after transportation, 34.9 ± 7.0; P = 0.000); a trend towards improved PO2/FiO2 ratio (before transportation, 318.0 ± 137.0 and after transportation, 356.8 ± 119.9; P = 0.053); increased heart rate (before transportation, 80.9 ± 18.7 and after transportation, 85.5 ± 17.6; P = 0.08); and no significant change in mean arterial blood pressure (P = 0.93). CONCLUSION: These results suggest that intrahospital transportation can be safely performed. Our low incidence of complications was possibly related to both the presence of a multidisciplinary transportation team and proper equipment.

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