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Background <p>Our objective was to characterize the impact of common initial sedation practices on invasive mechanical ventilation (IMV) duration and in-hospital outcomes in patients with acute brain injury (ABI) and to elucidate variations in practices between high-income and middle-income countries.</p> Methods <p>This was a post hoc analysis of a prospective observational data registry of neurocritically ill patients requiring IMV. The setting included 73 intensive care units (ICUs) in 18 countries, with a total of 1,450 patients with ABI requiring IMV. There were no interventions.</p> Results <p>Patients were categorized into day 1 propofol, midazolam, propofol and midazolam, dexmedetomidine, or sodium thiopental. The primary outcome was duration of IMV. Secondary outcomes were ICU and hospital mortality, ICU length of stay, days to first extubation, extubation failure, and withdrawal of life-sustaining therapy. Multivariable analyses were adjusted for clinically preselected covariates. Of 1,450 included patients (median age 54&#xa0;years, 66% male), 41.2% (<i>n</i> = 597) were started on propofol, 26.1% (<i>n</i> = 379) were started on midazolam, 19.9% were started on propofol and midazolam, 0.3% (<i>n</i> = 5) were started on sodium thiopental, 0.7% (<i>n</i> = 10) were started on dexmedetomidine, and 11.8% (<i>n</i> = 171) were treated without sedation. After adjustment, there was no significant difference in IMV duration between patients who received midazolam (aβ = 0.64, <i>p</i> = 0.43, 95% confidence interval [CI] − 0.96 to 2.24) or propofol and midazolam (aβ = 0.32, <i>p</i> = 0.46, 95% CI − 1.44 to 2.12) compared with patients who received propofol. Patients who were started on midazolam had an average length of ICU stay that was 2.78&#xa0;days longer than patients started on propofol (<i>p</i> = 0.003, 95% CI 0.94–4.63). There were no differences in mortality, days to first extubation, extubation failure, or withdrawal of life-sustaining therapy. Patients from high-income countries (<i>n</i> = 1,125) were more likely to receive propofol on day 1 (45.7 vs. 25.5%), whereas patients from middle-income countries (n = 325) were more likely to receive midazolam (32.6 vs. 24.3%) (<i>p</i> &lt; 0.001).</p> Conclusions <p>In an international registry of patients with ABI requiring IMV, IMV duration did not differ significantly relative to initial sedation strategy. However, patients started on midazolam had longer ICU stay.</p>

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Sedation Practices in Mechanically Ventilated Neurocritical Care Patients from 19 Countries: An International Cohort Study

  • 期刊论文

  • 发表日期：

    2025年1月7日

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  • Shi Nan Feng,
  • Lindsay H. Laws,
  • Camilo Diaz-Cruz,
  • Raphael Cinotti,
  • Marcus J. Schultz,
  • Karim Asehnoune,
  • Robert D. Stevens,
  • Chiara Robba,
  • Sung-Min Cho,
  • Paër-sélim Abback,
  • Anaïs Codorniu,
  • Giuseppe Citerio,
  • Vittoria Sala,
  • Marinella Astuto,
  • Eleonora Tringali,
  • Daniela Alampi,
  • Monica Rocco,
  • Jessica Maugeri,
  • Agrippino Bellissima,
  • Matteo Filippini,
  • Nicoletta Lazzeri,
  • Andrea Cortegiani,
  • Mariachiara Ippolito,
  • Chiara Robba,
  • Denise Battaglini,
  • Patrick Biston,
  • Mohamed Al-Gharyani,
  • Russell Chabanne,
  • Léo Astier,
  • Benjamin Soyer,
  • Samuel Gaugain,
  • Alice Zimmerli,
  • Urs Pietsch,
  • Miodrag Filipovic,
  • Giovanna Brandi,
  • Giulio Bicciato,
  • Ainhoa Serrano,
  • Berta Monleon,
  • Peter van Vliet,
  • Benjamin Gerretsen,
  • Iris Ortiz-Macias,
  • Jun Oto,
  • Noriya Enomoto,
  • Tomomichi Matsuda,
  • Nobutaka Masui,
  • Pierre Garçon,
  • Jonathan Zarka,
  • Wytze Vermeijden,
  • Alexander Cornet,
  • Sergio Inurrigarro,
  • Rafael Cirino Domínguez,
  • Maria Bellini,
  • Maria Gomez Haedo,
  • Laura Lamot,
  • Jose Orquera,
  • Matthieu Biais,
  • Delphine Georges,
  • Arvind Baronia,
  • Roberto Miranda-Ackerman,
  • Francisco Barbosa-Camacho,
  • John Porter,
  • Miguel Lopez-Morales,
  • Thomas Geeraerts,
  • Baptiste Compagnon,
  • David Pérez-Torres,
  • Estefanía Prol-Silva,
  • Hana Yahya,
  • Ala Khaled,
  • Mohamed Ghula,
  • Cracchiolo Andrea,
  • Palma Daniela,
  • Cristian Deana,
  • Luigi Vetrugno,
  • Manuel J. Chavez,
  • Rocio Trujillo,
  • Vincent Legros,
  • Benjamin Brochet,
  • Olivier Huet,
  • Marie Geslain,
  • Mathieu van der Jagt,
  • Job van Steenkiste,
  • Hazem Ahmed,
  • Alexander Coombs,
  • Jessie Welbourne,
  • Ana Velarde Pineda,
  • Víctor Nubert Castillo,
  • Mohammed A. Azab,
  • Ahmed Y. Azzam,
  • David van Meenen,
  • Gilberto Gasca,
  • Alfredo Arellano,
  • Forttino Galicia-Espinosa,
  • José García-Ramos,
  • Ghanshyam Yadav,
  • Amarendra Jha,
  • Vincent Robert-Edan,
  • Pierre-Andre Rodie-Talbere,
  • Gaurav Jain,
  • Sagarika Panda,
  • Sonika Agarwal,
  • Yashbir Deewan,
  • Gilberto Gasca,
  • Alfredo Arellano,
  • Syed Tariq Reza,
  • Md. Mozaffer Hossain,
  • Christos Papadas,
  • Vasiliki Chantziara,
  • Chrysanthi Sklavou,
  • Yannick Hourmant,
  • Nicolas Grillot,
  • Job van Steenkiste,
  • Mathieu van der Jagt,
  • Romain Pirracchio,
  • Abdelraouf Akkari,
  • Mohamed Abdelaty,
  • Ahmed Hashim,
  • Yoann Launey,
  • Elodie Masseret,
  • Sigismond Lasocki,
  • Soizic Gergaud,
  • Nicolas Mouclier,
  • Sulekha Saxena,
  • Avinash Agrawal,
  • Shakti Mishra,
  • Samir Samal,
  • Julio Mijangos,
  • Mattias Haënggi,
  • Mohan Gurjar,
  • Marcus Schultz,
  • Callum Kaye,
  • Daniela Godoy,
  • Pablo Alvarez,
  • Aikaterini Ioakeimidou,
  • Yoshitoyo Ueno,
  • Rafael Badenes,
  • Abdurrahmaan Suei Elbuzidi,
  • Michaël Piagnerelli,
  • Muhammed Elhadi,
  • Syed Reza,
  • Mohammed Azab,
  • Jean Digitale,
  • Nicholas Fong,
  • Ricardo Cerda,
  • Norma Peredo,
  • Romain Pirracchio,
  • Robert Stevens

摘要

Background

Our objective was to characterize the impact of common initial sedation practices on invasive mechanical ventilation (IMV) duration and in-hospital outcomes in patients with acute brain injury (ABI) and to elucidate variations in practices between high-income and middle-income countries.

Methods

This was a post hoc analysis of a prospective observational data registry of neurocritically ill patients requiring IMV. The setting included 73 intensive care units (ICUs) in 18 countries, with a total of 1,450 patients with ABI requiring IMV. There were no interventions.

Results

Patients were categorized into day 1 propofol, midazolam, propofol and midazolam, dexmedetomidine, or sodium thiopental. The primary outcome was duration of IMV. Secondary outcomes were ICU and hospital mortality, ICU length of stay, days to first extubation, extubation failure, and withdrawal of life-sustaining therapy. Multivariable analyses were adjusted for clinically preselected covariates. Of 1,450 included patients (median age 54 years, 66% male), 41.2% (n = 597) were started on propofol, 26.1% (n = 379) were started on midazolam, 19.9% were started on propofol and midazolam, 0.3% (n = 5) were started on sodium thiopental, 0.7% (n = 10) were started on dexmedetomidine, and 11.8% (n = 171) were treated without sedation. After adjustment, there was no significant difference in IMV duration between patients who received midazolam (aβ = 0.64, p = 0.43, 95% confidence interval [CI] − 0.96 to 2.24) or propofol and midazolam (aβ = 0.32, p = 0.46, 95% CI − 1.44 to 2.12) compared with patients who received propofol. Patients who were started on midazolam had an average length of ICU stay that was 2.78 days longer than patients started on propofol (p = 0.003, 95% CI 0.94–4.63). There were no differences in mortality, days to first extubation, extubation failure, or withdrawal of life-sustaining therapy. Patients from high-income countries (n = 1,125) were more likely to receive propofol on day 1 (45.7 vs. 25.5%), whereas patients from middle-income countries (n = 325) were more likely to receive midazolam (32.6 vs. 24.3%) (p < 0.001).

Conclusions

In an international registry of patients with ABI requiring IMV, IMV duration did not differ significantly relative to initial sedation strategy. However, patients started on midazolam had longer ICU stay.