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Longitudinal trajectories of sedation level and clinical outcomes in patients who are mechanically ventilated based on a group-based trajectory model: a prospective, multicentre, longitudinal and observational study in Korea
DC Field | Value | Language |
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dc.contributor.author | 남정모 | - |
dc.date.accessioned | 2024-03-22T06:03:31Z | - |
dc.date.available | 2024-03-22T06:03:31Z | - |
dc.date.issued | 2023-06 | - |
dc.identifier.uri | https://ir.ymlib.yonsei.ac.kr/handle/22282913/198366 | - |
dc.description.abstract | OBJECTIVES: Changes in sedation levels over a long time in patients who are mechanically ventilated are unknown. Therefore, we investigated the long-term sedation levels of these patients by classifying them into different longitudinal patterns. DESIGN: This was a multicentre, prospective, longitudinal, and observational study. SETTING: Twenty intensive care units (ICUs) spanning several medical institutions in Korea. PARTICIPANTS: Patients who received mechanical ventilation and sedatives in ICU within 48 hours of admission between April 2020 and July 2021. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary objective of this study was to identify the pattern of sedation practice. Additionally, we analysed the associations of trajectory groups with clinical outcomes as the secondary outcome. RESULTS: Sedation depth was monitored using Richmond Agitation-Sedation Scale (RASS). A group-based trajectory model was used to classify 631 patients into four trajectories based on sedation depth: persistent suboptimal (13.2%, RASS ≤ -3 throughout the first 30 days), delayed lightening (13.9%, RASS ≥ -2 after the first 15 days), early lightening (38.4%, RASS ≥ -2 after the first 7 days) and persistent optimal (34.6%, RASS ≥ -2 during the first 30 days). 'Persistent suboptimal' trajectory was associated with delayed extubation (HR: 0.23, 95% CI: 0.16 to 0.32, p<0.001), longer ICU stay (HR: 0.36, 95% CI: 0.26 to 0.51, p<0.001) and hospital mortality (HR: 13.62, 95% CI: 5.99 to 30.95, p<0.001) compared with 'persistent optimal'. The 'delayed lightening' and 'early lightening' trajectories showed lower extubation probability (HR: 0.30, 95% CI: 0.23 to 0.41, p<0.001; HR: 0.72, 95% CI: 0.59 to 0.87, p<0.001, respectively) and ICU discharge (HR: 0.44, 95% CI: 0.33 to 0.59, p<0.001 and HR: 0.80, 95% CI: 0.65 to 0.97, p=0.024) compared with 'persistently optimal'. CONCLUSIONS: Among the four trajectories, 'persistent suboptimal' trajectory was associated with higher mortality. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | - |
dc.description.statementOfResponsibility | open | - |
dc.language | English | - |
dc.publisher | BMJ Publishing Group Ltd | - |
dc.relation.isPartOf | BMJ OPEN | - |
dc.rights | CC BY-NC-ND 2.0 KR | - |
dc.subject.MESH | Humans | - |
dc.subject.MESH | Hypnotics and Sedatives* / therapeutic use | - |
dc.subject.MESH | Intensive Care Units | - |
dc.subject.MESH | Pain | - |
dc.subject.MESH | Prospective Studies | - |
dc.subject.MESH | Republic of Korea | - |
dc.subject.MESH | Respiration, Artificial* | - |
dc.title | Longitudinal trajectories of sedation level and clinical outcomes in patients who are mechanically ventilated based on a group-based trajectory model: a prospective, multicentre, longitudinal and observational study in Korea | - |
dc.type | Article | - |
dc.contributor.college | College of Medicine (의과대학) | - |
dc.contributor.department | Dept. of Preventive Medicine (예방의학교실) | - |
dc.contributor.googleauthor | Dong-Gon Hyun | - |
dc.contributor.googleauthor | Jee Hwan Ahn | - |
dc.contributor.googleauthor | Ha-Yeong Gil | - |
dc.contributor.googleauthor | Chung Mo Nam | - |
dc.contributor.googleauthor | Choa Yun | - |
dc.contributor.googleauthor | Chae-Man Lim | - |
dc.identifier.doi | 10.1136/bmjopen-2023-072628 | - |
dc.contributor.localId | A01264 | - |
dc.relation.journalcode | J00380 | - |
dc.identifier.eissn | 2044-6055 | - |
dc.identifier.pmid | 37369420 | - |
dc.subject.keyword | critical care | - |
dc.subject.keyword | deep sedation | - |
dc.subject.keyword | intensive care units | - |
dc.subject.keyword | mechanical ventilators | - |
dc.subject.keyword | mortality | - |
dc.contributor.alternativeName | Nam, Jung Mo | - |
dc.contributor.affiliatedAuthor | 남정모 | - |
dc.citation.volume | 13 | - |
dc.citation.number | 6 | - |
dc.citation.startPage | e072628 | - |
dc.identifier.bibliographicCitation | BMJ OPEN, Vol.13(6) : e072628, 2023-06 | - |
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