ICU sedation, delirium & recovery
Association of medication-induced deep sedation and emotional distress during mechanical ventilation with loss of independent living: an observational cohort study
Main findingResult — go to the resultRRadj 1.18 95% CI 1.13–1.23Authors' conclusion
Among mechanically ventilated adults in an ICU, the proportion of time spent in medication-induced deep sedation was independently associated with loss of independent living.
Study context
- Population
- Adults who lived independently before admission and were mechanically ventilated ≥24 h in 20 ICUs of an academic health system in the Bronx, New York (NY), US, and adjacent counties, 2016–2023
- Participants
- 10,204 adults
- Exposure
- High proportion vs None
- Outcome
- Loss of independent living (in-hospital death or postoperative discharge to a long-term skilled nursing facility)
Methodological detailsmulticentre (20 ICUs), a priori-defined confounder control model, modified Poisson regression, mediation analysis
- Multicentre (20 ICUs)
- A priori-defined confounder control model
- Modified Poisson regression
- Mediation analysis
Main finding
As reported in the abstract
RRadj
1.18
95% CI 1.13–1.23
P < 0.0001
- Loss of independent living, whole cohort
- 6369 (62.4%)
Observational data: associations, not effects.
Further findings
| Outcome | RRadj (CI) | P value |
|---|---|---|
| Loss of independent living by emotional distress (secondary exposure), high proportion vs none | 0.88 (0.84–0.92) | P < 0.0001 |
| Loss of independent living with symptom control by antipsychotics or non-opioid analgesics vs no treatment | 0.95 (0.91–0.99) | P = 0.013 |
| Loss of independent living with absence of patient mobility during mechanical ventilationMediation analysis | 1.32 (1.28–1.36) | P < 0.0001 |
- Loss of independent living by emotional distress (secondary exposure), high proportion vs none — Documented episodes of emotional distress
- 30 022
- Loss of independent living with absence of patient mobility during mechanical ventilation — Proportion of deep sedation effect mediated by absent mobility
- 32.5% (p<0.0001)
Delivered vs ordered deep sedation
- Proportion receiving deep sedation higher than proportion with an order for it, mean fold (SD 1.51)
- 2.84
- ≥1 episode of medication-induced deep sedation in first week
- 7289 (71.4%)
- Deeper sedation in response to emotional distress and during the night
- P < 0.0001
Original publication
Association of medication-induced deep sedation and emotional distress during mechanical ventilation with loss of independent living: an observational cohort study. Lancet Respir Med. Published 11 October 2025. doi:10.
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