Associations of Race With Sedation Depth Among Mechanically Ventilated Adults: A Retrospective Cohort Study

Deepa Ramadurai; Rachel Kohn; Joanna L Hart; Stefania Scott; Meeta Prasad Kerlin

doi:10.1097/CCE.0000000000000996

Associations of Race With Sedation Depth Among Mechanically Ventilated Adults: A Retrospective Cohort Study

Crit Care Explor. 2023 Oct 27;5(11):e0996. doi: 10.1097/CCE.0000000000000996. eCollection 2023 Nov.

Authors

Deepa Ramadurai^{1

2

3}, Rachel Kohn^{1

2

3}, Joanna L Hart^{1

2

3

4}, Stefania Scott², Meeta Prasad Kerlin^{1

2

3}

Affiliations

¹ Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
² Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
³ Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
⁴ Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Abstract

Objectives: To evaluate the association of race with proportion of time in deep sedation among mechanically ventilated adults.

Design: Retrospective cohort study from October 2017 to December 2019.

Setting: Five hospitals within a single health system.

Patients: Adult patients who identified race as Black or White who were mechanically ventilated for greater than or equal to 24 hours in one of 12 medical, surgical, cardiovascular, cardiothoracic, or mixed ICUs.

Interventions: None.

Measurements and main results: The exposure was White compared with Black race. The primary outcome was the proportion of time in deep sedation during the first 48 hours of mechanical ventilation, defined as Richmond Agitation-Sedation Scale values of -3 to -5. For the primary analysis, we performed mixed-effects linear regression models including ICU as a random effect, and adjusting for age, sex, English as preferred language, body mass index, Elixhauser comorbidity index, Laboratory-based Acute Physiology Score, Version 2, ICU admission source, admission for a major surgical procedure, and the presence of septic shock. Of the 3337 included patients, 1242 (37%) identified as Black, 1367 (41%) were female, and 1002 (30%) were admitted to a medical ICU. Black patients spent 48% of the first 48 hours of mechanical ventilation in deep sedation, compared with 43% among White patients in unadjusted analysis. After risk adjustment, Black race was significantly associated with more time in early deep sedation (mean difference, 5%; 95% CI, 2-7%; p < 0.01).

Conclusions: There are disparities in sedation during the first 48 hours of mechanical ventilation between Black and White patients across a diverse set of ICUs. Future work is needed to determine the clinical significance of these findings, given the known poorer outcomes for patients who experience early deep sedation.

Keywords: critical care outcomes; deep sedation; healthcare disparities; intensive care units; respiratory failure.

Abstract

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