Secondary Logo

Share this article on:


Bose, Somnath; Ghosh, Erina; He, Ze; Gollub, Randy; Ge, Zhifei

doi: 10.1097/01.ccm.0000528112.87768.3a
Star Research Presentation: Epidemiology and Outcomes

1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 2Philips Research North America, Cambridge, MA, 3Phillips Research North America, Cambridge, MA, 4Massachusetts General Hospital, Harvard Medical School, Boston, MA, Boston, MA, 5Cam Med LLC, Lowell, MA

Learning Objectives: Mechanically ventilated patients in Intensive Care Units (ICUs) receive sedation and analgesia for comfort and ventilator synchrony. Deeper level of sedation has been associated with worse outcomes. Practice guidelines emphasize minimizing sedative use and use of targeted sedation strategies. Previous small studies conducted in medical ICUs have shown that patients receive more sedatives/analgesics at night. We examined differences in day and nighttime sedative/analgesic use in a large cohort of medical and surgical ICU patients admitted to an academic medical center.

Methods: Retrospective cohort study using open source MIMIC III database. Index admission of adult patients admitted to the Medical (MICU) and Surgical ICUs (SICU) of BIDMC between 2008–2012 and mechanically ventilated > 48 hours were included. Patients with neurological disorders, not committed to full care (DNR/DNI/CMO) or receiving infusion of paralytic agents were excluded. Sedative/analgesic drug use was computed for each shift (700–1859 PM and 1900-0659 AM) and converted to opioids (OP:Morphine equivalents), benzodiazepines (BZD:Lorazepam equivalents), propofol (PF) and dexmedetomidine (DT). Wilcoxon paired sign rank test was used to assess within patient differences between day and night time use of each medication class.

Results: 2,277 ICU admissions were included. 34.9% admissions were in medical ICUs. Median SOFA score was 5 (3–8); duration of mechanical ventilation was 3.71 (2.71–6.04) days and ICU LOS was 4.90 (3.27–8.40) days. Patients received more BZD and OP at night (median difference 0.009 and 0.05mg/hr respectively). PF and DT use was higher during the day (median difference 0.72mg/hr and 0.16μg/hr). This pattern of BZD and OP use was consistent across medical/surgical units. There was no difference between day/night dosing of PF (p = 0.22) in MICU or DT dosing in SICU (p = 0.14). Although differences between day and night time dosing of sedatives (BZD, DT, PF) and OP across all ICUs reached statistical significance (p < 0.05), the small effect sizes indicated that these differences were not likely to be clinically meaningful.

Conclusions: Although statistically significant, there is no clinically meaningful difference in day and night time use of sedatives and analgesics in our mixed cohort of medical/surgical ICU patients. This may reflect adoption of targeted sedation strategies.

Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.