Mekanik Ventilasyondaki Yetişkinlerde Erken Derin-hafif Sedasyon ve Sürekli Hafif veya Uyanık Stratejisinin Karşılaştırılması

Özet (abstract)

Abstract Observational studies comparing sedation depth strategies in mechanically ventilated patients have relied on observed consciousness levels alone to define exposure, potentially conflating intentional drug-induced sedation with low arousal caused by residual medications, other agents, or underlying illness. We applied the target trial emulation framework with the clone-censor-weight method to compare early deep-to-light sedation (DTLS) versus a sustained light-or-awake strategy, using a joint exposure definition that requires both Richmond Agitation-Sedation Scale (RASS) depth and qualifying continuous sedative infusion. Using MIMIC-IV (2008–2022), we identified 5,086 adults receiving invasive mechanical ventilation for ≥ 48 h. Each patient was cloned to both strategies. During the primary 144-hour adherence window, inverse probability weights accounted for measured predictors of artificial censoring. The primary outcome was 28-day ventilator-free days (VFDs); successful extubation was analysed with death as a competing event. VFD outcomes were observed before artificial censoring in 1,481 sustained-light-or-awake and 622 DTLS clones. Weighted mean VFDs were 17.72 days for DTLS versus 17.76 days for sustained light-or-awake, a difference of − 0.04 days (95% CI, − 1.32–1.29). The cause-specific extubation HR was 0.97 (95% CI, 0.84–1.11). A sensitivity cohort without future minimum ventilation or ICU-duration requirements ( n = 15,842) showed fewer VFDs with DTLS (difference, − 1.03 days; 95% CI, − 1.47 to − 0.61). These findings do not establish a DTLS benefit; duration-based selection, residual confounding, and limited late-window support constrain interpretation.

Yazarların özeti; kaynağından alınmıştır. Scientific Reports, 2026 · DOI ↗