Cardiac Arrest Treatment Center Differences in Sedation and Analgesia Dosing During Targeted Temperature Management
Ceric, Ameldina LU ; May, Teresa L. ; Lybeck, Anna LU
; Cronberg, Tobias
LU
; Seder, David B.
; Riker, Richard R.
; Hassager, Christian
; Kjaergaard, Jesper
; Haxhija, Zana
LU
and Friberg, Hans
LU
, et al.
(2023)
In Neurocritical Care
38(1).
p.16-25
- Abstract
Background: Sedation and analgesia are recommended during targeted temperature management (TTM) after cardiac arrest, but there are few data to provide guidance on dosing to bedside clinicians. We evaluated differences in patient-level sedation and analgesia dosing in an international multicenter TTM trial to better characterize current practice and clinically important outcomes. Methods: A total 950 patients in the international TTM trial were randomly assigned to a TTM of 33 °C or 36 °C after resuscitation from cardiac arrest in 36 intensive care units. We recorded cumulative doses of sedative and analgesic drugs at 12, 24, and 48 h and normalized to midazolam and fentanyl equivalents. We compared number of medications used, dosing,... (More)
Background: Sedation and analgesia are recommended during targeted temperature management (TTM) after cardiac arrest, but there are few data to provide guidance on dosing to bedside clinicians. We evaluated differences in patient-level sedation and analgesia dosing in an international multicenter TTM trial to better characterize current practice and clinically important outcomes. Methods: A total 950 patients in the international TTM trial were randomly assigned to a TTM of 33 °C or 36 °C after resuscitation from cardiac arrest in 36 intensive care units. We recorded cumulative doses of sedative and analgesic drugs at 12, 24, and 48 h and normalized to midazolam and fentanyl equivalents. We compared number of medications used, dosing, and titration among centers by using multivariable models, including common severity of illness factors. We also compared dosing with time to awakening, incidence of clinical seizures, and survival. Results: A total of 614 patients at 18 centers were analyzed. Propofol (70%) and fentanyl (51%) were most frequently used. The average dosages of midazolam and fentanyl equivalents were 0.13 (0.07, 0.22) mg/kg/h and 1.16 (0.49, 1.81) µg/kg/h, respectively. There were significant differences in number of medications (p < 0.001), average dosages (p < 0.001), and titration at all time points between centers (p < 0.001), and the outcomes of patients in these centers were associated with all parameters described in the multivariate analysis, except for a difference in the titration of sedatives between 12 and 24 h (p = 0.40). There were associations between higher dosing at 48 h (p = 0.003, odds ratio [OR] 1.75) and increased titration of analgesics between 24 and 48 h (p = 0.005, OR 4.89) with awakening after 5 days, increased titration of sedatives between 24 and 48 h with awakening after 5 days (p < 0.001, OR > 100), and increased titration of sedatives between 24 and 48 h with a higher incidence of clinical seizures in the multivariate analysis (p = 0.04, OR 240). There were also significant associations between decreased titration of analgesics and survival at 6 months in the multivariate analysis (p = 0.048). Conclusions: There is significant variation in choice of drug, dosing, and titration when providing sedation and analgesics between centers. Sedation and analgesia dosing and titration were associated with delayed awakening, incidence of clinical seizures, and survival, but the causal relation of these findings cannot be proven.
(Less)
- author
- Ceric, Ameldina
LU
; May, Teresa L.
; Lybeck, Anna
LU
; Cronberg, Tobias
LU
; Seder, David B.
; Riker, Richard R.
; Hassager, Christian
; Kjaergaard, Jesper
; Haxhija, Zana
LU
and Friberg, Hans
LU
, et al. (More)
- Ceric, Ameldina
LU
; May, Teresa L.
; Lybeck, Anna
LU
; Cronberg, Tobias
LU
; Seder, David B.
; Riker, Richard R.
; Hassager, Christian
; Kjaergaard, Jesper
; Haxhija, Zana
LU
; Friberg, Hans
LU
; Dankiewicz, Josef
LU
and Nielsen, Niklas
LU
(Less)
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Analgesia, Analgosedation, Cardiac arrest, Sedation, Seizures, Target temperature management
- in
- Neurocritical Care
- volume
- 38
- issue
- 1
- pages
- 16 - 25
- publisher
- Humana Press
- external identifiers
-
- scopus:85135268385
- pmid:35896768
- ISSN
- 1541-6933
- DOI
- 10.1007/s12028-022-01564-6
- language
- English
- LU publication?
- yes
- id
- 0e11e70d-338b-4613-8b81-14af9d76597e
- date added to LUP
- 2022-11-29 11:22:43
- date last changed
- 2024-06-23 23:50:20
@article{0e11e70d-338b-4613-8b81-14af9d76597e,
abstract = {{<p>Background: Sedation and analgesia are recommended during targeted temperature management (TTM) after cardiac arrest, but there are few data to provide guidance on dosing to bedside clinicians. We evaluated differences in patient-level sedation and analgesia dosing in an international multicenter TTM trial to better characterize current practice and clinically important outcomes. Methods: A total 950 patients in the international TTM trial were randomly assigned to a TTM of 33 °C or 36 °C after resuscitation from cardiac arrest in 36 intensive care units. We recorded cumulative doses of sedative and analgesic drugs at 12, 24, and 48 h and normalized to midazolam and fentanyl equivalents. We compared number of medications used, dosing, and titration among centers by using multivariable models, including common severity of illness factors. We also compared dosing with time to awakening, incidence of clinical seizures, and survival. Results: A total of 614 patients at 18 centers were analyzed. Propofol (70%) and fentanyl (51%) were most frequently used. The average dosages of midazolam and fentanyl equivalents were 0.13 (0.07, 0.22) mg/kg/h and 1.16 (0.49, 1.81) µg/kg/h, respectively. There were significant differences in number of medications (p < 0.001), average dosages (p < 0.001), and titration at all time points between centers (p < 0.001), and the outcomes of patients in these centers were associated with all parameters described in the multivariate analysis, except for a difference in the titration of sedatives between 12 and 24 h (p = 0.40). There were associations between higher dosing at 48 h (p = 0.003, odds ratio [OR] 1.75) and increased titration of analgesics between 24 and 48 h (p = 0.005, OR 4.89) with awakening after 5 days, increased titration of sedatives between 24 and 48 h with awakening after 5 days (p < 0.001, OR > 100), and increased titration of sedatives between 24 and 48 h with a higher incidence of clinical seizures in the multivariate analysis (p = 0.04, OR 240). There were also significant associations between decreased titration of analgesics and survival at 6 months in the multivariate analysis (p = 0.048). Conclusions: There is significant variation in choice of drug, dosing, and titration when providing sedation and analgesics between centers. Sedation and analgesia dosing and titration were associated with delayed awakening, incidence of clinical seizures, and survival, but the causal relation of these findings cannot be proven.</p>}},
author = {{Ceric, Ameldina and May, Teresa L. and Lybeck, Anna and Cronberg, Tobias and Seder, David B. and Riker, Richard R. and Hassager, Christian and Kjaergaard, Jesper and Haxhija, Zana and Friberg, Hans and Dankiewicz, Josef and Nielsen, Niklas}},
issn = {{1541-6933}},
keywords = {{Analgesia; Analgosedation; Cardiac arrest; Sedation; Seizures; Target temperature management}},
language = {{eng}},
number = {{1}},
pages = {{16--25}},
publisher = {{Humana Press}},
series = {{Neurocritical Care}},
title = {{Cardiac Arrest Treatment Center Differences in Sedation and Analgesia Dosing During Targeted Temperature Management}},
url = {{http://dx.doi.org/10.1007/s12028-022-01564-6}},
doi = {{10.1007/s12028-022-01564-6}},
volume = {{38}},
year = {{2023}},
}