Early Sedation Intensity and Psychological Outcomes in Critically Ill Adults.
Mikiko Iwatani, Michiko Morimoto
PMID 42049634WHAT IT FOUND
Sedation intensity in the first 24 h of mechanical ventilation was not associated with anxiety, depression or PTSD symptoms 3 months after ICU discharge.
Agitation during ICU stay was associated with psychological impairment.
Key findings
01Sedation intensity during the first 24 h of mechanical ventilation was not associated with psychological impairment 3 months after ICU discharge, after adjustment for illness severity, agitation, pain and delirium.
02Any agitation during the ICU stay was associated with psychological impairment, with an adjusted odds ratio of 2.61 (90% CI 1.16 to 5.88, p = 0.05).
03Fifty-seven participants (43.9%) met the criteria for psychological impairment 3 months after ICU discharge.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 130 patients were analysed, and no sample size calculation was performed for this ancillary study, so a real association could have been missed. The Sedation Index and Agitation Index were derived from RASS scores but have not been formally validated as standard clinical tools. Psychological impairment was based on symptom cut-offs, not formal psychiatric diagnoses. The cohort was mostly postoperative, had relatively short ventilation, and sedation exposure was clustered, which may limit detection of a dose-response relationship. Data were collected from 2011 to 2013 in ICUs that already avoided midazolam and used analgesia-first and early mobilisation, so current or other settings may differ. The study used 90% confidence intervals and was exploratory, so it was designed to reduce false negatives rather than prove absence of effect.
Declared interests
The authors reported no funding disclosures and no conflicts of interest.
The easy way to misread this
Do not conclude that early sedation intensity is irrelevant to psychological outcomes. The study was small, retrospective and exploratory, and clinically meaningful associations could not be excluded.