SEDATION DEPTH DURING CRITICAL CARE TRANSPORT AND HOSPITALIZATION

M HAROON; . SULAIMAN; MJ KHAN; IU HAQ; S AHMAD; S MALIK

doi:10.54112/bcsrj.v2024i1.756

Authors

M HAROON Department of Medicine/ Medical ICU , Khyber Teaching Hospital Peshawar, Pakistan
. SULAIMAN Cardiac Rehabilitation Centre, Hayatabad Medical Complex Peshawar, Pakistan
MJ KHAN Department of Anaesthesia, Khyber Teaching Hospital Peshawar, Pakistan
IU HAQ Department of Anaesthesia and Surgical ICU (Incharge), Khyber Teaching Hospital Peshawar, Pakistan
S AHMAD Department of Pulmonology, Khyber Teaching Hospital Peshawar, Pakistan
S MALIK Department of Anaesthesia, Jinnah Postgraduate Medical Center, Karachi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.756

Keywords:

RASS, Deep sedation, critically ill patients, transport

Abstract

The purpose of this study was to determine the differences in attained levels of sedation both within intensive care units and collectively regarding overall outcomes when patients were transported outside a hospital either pre-hospital or while being inter-facility transfer by different critical care agencies, having been exposed to light versus deep quality of anaesthesia. After the ethical approval from the institutional review board, this cross-sectional study was conducted at Khyber Teaching Hospital from 01/06/22 to 31/12/22. The primary outcome measure was the relation of starting deep sedation during transport to deep sedation in the first 48 hours after admission (defined as RASS -3 and less). Secondary outcomes included mechanical ventilation duration, inpatient mortality, total hospital stay length of ICU, and delirium within 48 h; coma may also be observed. Final transport RASS in both the study groups was-4.43±0.49 and-1.5±0.5 (p <0.0001). Mean Hospital duration in both study groups was 13.01±4.8 and 35±5.9 days (p<0.0001). A high percentage of inpatient mortality, delirium, and coma cases was seen in the deep sedation group (p<0.0001). The transfer of patient care from the transport team to the hospital team presents a chance to potentially interrupt the progress of treatment and reassess decisions regarding sedation.

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References

Aragón, R. E., Proaño, A., Mongilardi, N., De Ferrari, A., Herrera, P., Roldan, R., Paz, E., Jaymez, A. A., Chirinos, E., and Portugal, J. (2019). Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort. Critical Care 23, 1-9.

Celis-Rodríguez, E., Cortés, J. D., Bolívar, Y. C., González, J. C., Pinilla, D.-I., Záccaro, L. F., Birchenall, C., López, J. C., Argüello, B., and Abrego, G. C. (2020). Evidence-based clinical practice guidelines for the management of sedoanalgesia and delirium in critically ill adult patients. Medicina Intensiva (English Edition) 44, 171-184.

Ceric, A., Holgersson, J., May, T., Skrifvars, M. B., Hästbacka, J., Saxena, M., Aneman, A., Delaney, A., Reade, M. C., and Delcourt, C. (2022). Level of sedation in critically ill adult patients: a protocol for a systematic review with meta-analysis and trial sequential analysis. BMJ open 12, e061806.

Freeman, C. L., Evans, C. S., and Barrett, T. W. (2020). Managing sedation in the mechanically ventilated emergency department patient: a clinical review. Journal of the American College of Emergency Physicians Open 1, 263-269.

Fuller, B. M., Roberts, B. W., Mohr, N. M., Knight IV, W. A., Adeoye, O., Pappal, R. D., Marshall, S., Alunday, R., Dettmer, M., and Goyal, M. (2019). The ED-SED study: a multicenter, prospective cohort study of practice patterns and clinical outcomes associated with emergency department sedation for mechanically ventilated patients. Critical care medicine 47, 1539-1548.

George, B. P., Vakkalanka, J. P., Harland, K. K., Faine, B., Rewitzer, S., Zepeski, A., Fuller, B. M., Mohr, N. M., and Ahmed, A. (2020). Sedation depth is associated with increased hospital length of stay in mechanically ventilated air medical transport patients: a cohort study. Prehospital emergency care 24, 783-792.

Girard, T. D., Kress, J. P., Fuchs, B. D., Thomason, J. W., Schweickert, W. D., Pun, B. T., Taichman, D. B., Dunn, J. G., Pohlman, A. S., and Kinniry, P. A. (2008). Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. The Lancet 371, 126-134.

Levito, M. N., McGinnis, C. B., Groetzinger, L. M., Durkin, J. B., and Elmer, J. (2021). Impact of benzodiazepines on time to awakening in post cardiac arrest patients. Resuscitation 165, 45-49.

Moy, H. P., Olvera, D., Nayman, B. D., Pappal, R. D., Hayes, J. M., Mohr, N. M., Kollef, M. H., Palmer, C. M., Ablordeppey, E., and Faine, B. (2021). The AIR-SED study: A multicenter cohort study of SEDation practices, deep sedation, and coma among mechanically ventilated AIR transport patients. Critical care explorations 3, e0597.

Olfson, M., King, M., and Schoenbaum, M. (2015). Benzodiazepine use in the United States. JAMA psychiatry 72, 136-142.

Roginski, M. A., Carroll, M. C., Trautwein, M. L., Watkins, E. D., and Esteves, A. M. (2023). Sedation Practices of Mechanically Ventilated Patients During Critical Care Transport. Air Medical Journal 42, 343-347.

Stephens, R. J., Evans, E. M., Pajor, M. J., Pappal, R. D., Egan, H. M., Wei, M., Hayes, H., Morris, J. A., Becker, N., and Roberts, B. W. (2022). A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study. Critical Care 26, 179.