Effect of Analgesia-first Sedation on Sedative Exposure and Clinical Outcomes in a Medical Intensive Care Unit
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Publication Date
2025
Keywords
oregon, oaa 2025, psvmc
Disciplines
Critical Care | Medical Education | Pharmacy and Pharmaceutical Sciences
Abstract
Abstract: Utilizing analgesia-first over sedation-first strategies in mechanically ventilated (MV) patients is recommended by the Society of Critical Care Medicine and is associated with improved outcomes, including more ventilator-free days and reduced intensive care unit (ICU) and hospital lengths of stay (LOS). Adequate pain control reduces agitation and discomfort, thereby decreasing the need for deeper sedation. This single-center, retrospective cohort study aims to describe current analgesia-first sedation practices in the medical ICU and evaluate their impact on sedative requirements and clinical outcomes. Adult patients (≥18 years) admitted to Providence St. Vincent Medical Center and mechanically ventilated for ≥24 hours between October 1, 2022, and September 30, 2024, will be included. Epic Slicer Dicer will be used for patient identification, and REDCap for data collection. Exclusion criteria include comfort care status, ICU LOS < 24 hours, MV duration >7 days, use of continuous paralytics or epidural analgesia, or deep sedation (e.g., status epilepticus). Patients will be categorized into quartiles based on the distribution of predefined analgesia-first actions, guided by objective measures such as the Critical-Care Pain Observation Tool (CPOT) and Richmond Agitation-Sedation Scale (RASS) scores. The primary outcome is time to extubation (hours). Secondary outcomes include ICU LOS, 30-day mortality, and mean cumulative analgesic and sedative doses per patient, median RASS scores, CPOT scores, incidence of reintu-bation within 24 hours, and incidence of delirium. Data collection will include baseline characteristics, relevant comorbidities, baseline Sequential Organ Failure Assessment (SOFA) scores, MV duration, ICU and hospital LOS, 30-day mortality, and pain and sedation metrics. The primary outcome will be analyzed using ANOVA, and secondary outcomes will be assessed with Wilcoxon rank-sum or Student’s t-tests, depending on data normality. A p-value < 0.05 will be considered statistically significant. Results and conclusions will be reported upon project completion. (IRB approved) Learning Objectives: 1. Explain the rationale and clinical benefits of an analgesia-first sedation strategy in mechanically ventilated patients. 2. Describe the study design and methods used to evaluate sedation practices in the ICU setting. 3. Assess the impact of analgesia-first sedation on clinical outcomes such as time to to extubation, ICU length of stay, and sedation requirements. Presentation Category: Critical Care
Specialty/Research Institute
Critical Care Medicine
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Pharmacy
