Sedation practices and 28 day clinical outcomes among mechanically ventilated adult patients in Uganda's ICUs : a prospective longitudinal multicentre study

Abstract

Introduction: Sedation is a common intervention among mechanically ventilated patients in the Intensive care units (ICUs) to facilitate anxiolysis, improve ventilator synchrony, and prevent agitation. Its use has been independently associated with various outcomes, including mortality. Therefore, understanding sedation practices among these patients is essential to identify the causes of poor clinical outcomes in our settings. However, the available literature on this topic in developing countries remains limited. Objective: To describe the sedation practices and their 28-day clinical outcomes among mechanically ventilated adult patients in ICUs. Methodology: This was a prospective longitudinal multicentre study carried out in three ICUs in Uganda, where a total of 222 participants were recruited between 24 and 48 hours after the initiation of mechanical ventilation. Patient files, assessment of the depth of and ascertainment of a running sedative from the patient’s bedside were used for data collection and followed up for the 28-day clinical outcomes. Data was entered using Epidata software (version 4.6) and where appropriate summarised into means, standard deviations, medians, and interquartile ranges and presented in tables, charts, and graphs. Results: In this study, sedation was administered in 119 patients (53%), with 113 (95%) of these patients having their sedation target set. Among the sedated patients, 81.5% had their sedation depth monitored using RASS and GCS in 68.4% and 31.6%, respectively. Midazolam was the most commonly used sedative agent in eighty-three patients (69.7%). Most patients were lightly sedated for most of the days on mechanical ventilation. No association was found between the duration of mechanical ventilation, length of ICU stay, ICU mortality, and sedation. Conclusion: The use of sedation among adults undergoing mechanical ventilation in ICU should be individualised to meet the patients’ requirements. Further research is needed to optimize sedation practices