Organizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU database

Detalhes bibliográficos
Autor(a) principal: Nassar Jr., Antonio Paulo
Data de Publicação: 2019
Outros Autores: Zampieri, Fernando G., Salluh, Jorge I., Bozza, Fernando A., Machado, Flávia Ribeiro, Guimarães, Helio Penna, Damiani, Lucas P., Cavalcanti, Alexandre Biasi
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/32070
Resumo: A.C. Camargo Cancer Center. Intensive Care Unit and Postgraduate Program. São Paulo, SP, Brazil.
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spelling Nassar Jr., Antonio PauloZampieri, Fernando G.Salluh, Jorge I.Bozza, Fernando A.Machado, Flávia RibeiroGuimarães, Helio PennaDamiani, Lucas P.Cavalcanti, Alexandre Biasi2019-03-14T12:06:30Z2019-03-14T12:06:30Z2019NASSAR JR., Antonio Paulo et al. Organizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU database. Critical Care, v. 23, n. 34, p. 1-8, 2019.1364-8535https://www.arca.fiocruz.br/handle/icict/3207010.1186/s13054-019-2323-y1466-609XengBMCOrganizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU databaseinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleA.C. Camargo Cancer Center. Intensive Care Unit and Postgraduate Program. São Paulo, SP, Brazil.Hospital do Coração. Research Institute. São Paulo, SP, Brazil / Hospital Alemão Oswaldo Cruz. São Paulo, SP, Brasil.D’Or Institute for Research and Education. Graduate Program in Translational Medicine and Department of Critical Care. Rio De Janeiro, RJ, Brazil / Universidade Federal do Rio de Janeiro. Programa de Pós-Graduação em Clinica médica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto D’Or de Pesquisa e Ensino. Rio de Janeiro, RJ, Brazil.Federal University of São Paulo. Anesthesiology, Pain and Intensive Care Department. São Paulo, SP, Brazil.Hospital do Coração. Research Institute. São Paulo, SP, Brazil / Federal university of São Paulo. São Paulo, SP, Brazil.Hospital do Coração. Research Institute. São Paulo, SP, Brazil.Hospital do Coração. Research Institute. São Paulo, SP, Brazil.Background: Although light sedation levels are associated with several beneficial outcomes for critically ill patients on mechanical ventilation, the majority of patients are still deeply sedated. Organizational factors may play a role on adherence to light sedation levels. We aimed to identify organizational factors associated with a moderate to light sedation target on the first 48 h of mechanical ventilation, as well as the association between early achievement of within-target sedation and mortality. Methods: This study is a secondary analysis of a multicenter two-phase study (prospective cohort followed by a cluster-randomized controlled trial) performed in 118 Brazilian ICUs. We included all critically ill patients who were on mechanical ventilation 48 h after ICU admission. A moderate to light level of sedation or being alert and calm (i.e., the Richmond Agitation-Sedation Scale of − 3 to 0) was the target for all patients on mechanical ventilation during the study period. We collected data on the type of hospital (public, private, profit and private, nonprofit), hospital teaching status, nursing and physician staffing, and presence of sedation, analgesia, and weaning protocols. We used multivariate random-effects regression with ICU and study phase as random-effects and correction for patients’ Simplified Acute Physiology Score 3 and Sequential Organ Failure Assessment. We also performed a mediation analysis to explore whether sedation level was just a mediator of the association between organizational factors and mortality. Results: We included 5719 patients. Only 1710 (29.9%) were on target sedation levels on day 2. Board-certified intensivists on the morning and afternoon shifts were associated with an adequate sedation level on day 2 (OR = 2.43; CI 95%, 1.09–5. 38). Target sedation levels were associated with reduced hospital mortality (OR = 0.63; CI 95%, 0.55–0.72). Mediation analysis also suggested such an association, but did not suggest a relationship between the physician staffing model and hospital mortality. Conclusions: Board-certified intensivists on morning and afternoon shifts were associated with an increased number of patients achieving lighter sedation goals. These findings reinforce the importance of organizational factors, such as intensivists’ presence, as a modifiable quality improvement target.Conscious sedationCritical careDeep sedationMechanical ventilationOutcome and process assessmentinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-82991https://www.arca.fiocruz.br/bitstream/icict/32070/1/license.txt5a560609d32a3863062d77ff32785d58MD51ORIGINALve_Nassar Jr_Antonio_etal_INI_2019.pdfve_Nassar Jr_Antonio_etal_INI_2019.pdfapplication/pdf637086https://www.arca.fiocruz.br/bitstream/icict/32070/2/ve_Nassar%20Jr_Antonio_etal_INI_2019.pdf5f79152e02f833cc2f7cc756fcbfb8a6MD52TEXTve_Nassar Jr_Antonio_etal_INI_2019.pdf.txtve_Nassar Jr_Antonio_etal_INI_2019.pdf.txtExtracted 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dc.title.pt_BR.fl_str_mv Organizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU database
title Organizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU database
spellingShingle Organizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU database
Nassar Jr., Antonio Paulo
Conscious sedation
Critical care
Deep sedation
Mechanical ventilation
Outcome and process assessment
title_short Organizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU database
title_full Organizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU database
title_fullStr Organizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU database
title_full_unstemmed Organizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU database
title_sort Organizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU database
author Nassar Jr., Antonio Paulo
author_facet Nassar Jr., Antonio Paulo
Zampieri, Fernando G.
Salluh, Jorge I.
Bozza, Fernando A.
Machado, Flávia Ribeiro
Guimarães, Helio Penna
Damiani, Lucas P.
Cavalcanti, Alexandre Biasi
author_role author
author2 Zampieri, Fernando G.
Salluh, Jorge I.
Bozza, Fernando A.
Machado, Flávia Ribeiro
Guimarães, Helio Penna
Damiani, Lucas P.
Cavalcanti, Alexandre Biasi
author2_role author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Nassar Jr., Antonio Paulo
Zampieri, Fernando G.
Salluh, Jorge I.
Bozza, Fernando A.
Machado, Flávia Ribeiro
Guimarães, Helio Penna
Damiani, Lucas P.
Cavalcanti, Alexandre Biasi
dc.subject.en.pt_BR.fl_str_mv Conscious sedation
Critical care
Deep sedation
Mechanical ventilation
Outcome and process assessment
topic Conscious sedation
Critical care
Deep sedation
Mechanical ventilation
Outcome and process assessment
description A.C. Camargo Cancer Center. Intensive Care Unit and Postgraduate Program. São Paulo, SP, Brazil.
publishDate 2019
dc.date.accessioned.fl_str_mv 2019-03-14T12:06:30Z
dc.date.available.fl_str_mv 2019-03-14T12:06:30Z
dc.date.issued.fl_str_mv 2019
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.citation.fl_str_mv NASSAR JR., Antonio Paulo et al. Organizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU database. Critical Care, v. 23, n. 34, p. 1-8, 2019.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/32070
dc.identifier.issn.pt_BR.fl_str_mv 1364-8535
dc.identifier.doi.none.fl_str_mv 10.1186/s13054-019-2323-y
dc.identifier.eissn.none.fl_str_mv 1466-609X
identifier_str_mv NASSAR JR., Antonio Paulo et al. Organizational factors associated with target sedation on the first 48h of mechanical ventilation: an analysis of checklist-ICU database. Critical Care, v. 23, n. 34, p. 1-8, 2019.
1364-8535
10.1186/s13054-019-2323-y
1466-609X
url https://www.arca.fiocruz.br/handle/icict/32070
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv BMC
publisher.none.fl_str_mv BMC
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
instname:Fundação Oswaldo Cruz (FIOCRUZ)
instacron:FIOCRUZ
instname_str Fundação Oswaldo Cruz (FIOCRUZ)
instacron_str FIOCRUZ
institution FIOCRUZ
reponame_str Repositório Institucional da FIOCRUZ (ARCA)
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