Sedation Depth in Acute Respiratory Distress Syndrome Patients Receiving Neuromuscular Blockade: A Prospective Observational Study
Authors' conclusion
Among paralyzed ICU patients receiving NMBA, a substantial proportion demonstrated indices consistent with potential inadequate sedation despite standard protocols; explicit awareness was not assessed.
Study context
- Population
- Adults with ARDS receiving continuous neuromuscular blockade (NMBA) infusions for at least 24 hours, sedated with propofol and/or midazolam plus fentanyl
- Participants
- 60 adults
- Outcome
- Sedation depth using processed EEG (processed electroencephalography (pEEG))
Methodological detailssingle-centre tertiary intensive care unit (ICU)
- Single-centre tertiary ICU
Main finding
As reported in the abstract
PSI (deep <25, adequate 25-50, potentially inadequate >50)
Median Patient State Index (PSI)
53.3
Patients with PSI >50 (potentially inadequate sedation)
50%
Patients with PSI >75
16.7%
Observational data: associations, not effects.
Secondary outcomes
PSI by sedative regimen
- Significantly lower PSI with propofol plus midazolam vs single-agent groups
- P < 0.001
Temporal trends in PSI, SEF-R and SEF-L (T0-T24)
- PSI decreased significantly from T0 to subsequent time points
- overall p < 0.001
- SEF-R and SEF-L also showed significant time effects
Haemodynamics, adequately vs inadequately sedated patients
- No significant hemodynamic differences
Original publication
Sedation Depth in Acute Respiratory Distress Syndrome Patients Receiving Neuromuscular Blockade: A Prospective Observational Study. J Cardiothorac Vasc Anesth. Published 26 October 2025. doi:10.
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