ICU sedation, delirium & recovery
Sedation trajectories and circadian rhythm disruption in critically ill adults: an observational cohort study with external validation using MIMIC-IV and eICU-CRD
Authors' conclusion
ICU sedation trajectories were associated with vital-sign rhythmicity parameters. Temperature-derived rhythmicity was consistent with an exploratory indirect pathway to delirium, but estimates depended on analytic assumptions.
Study context
- Population
- Surgical and mixed medical-surgical ICU patients (MIMIC-IV)eICU-CRD validation n = 12,004
- Participants
- 13,592 participants
- Exposure
- Sedation trajectories vs sustained high-dose propofol
- Outcome
- Rhythmicity parameters of four vital signs (Lomb-Scargle, wavelet, entropy, cosinor methods)
Methodological detailsexternal validation (eICU-CRD), marginal structural models, exploratory mediation analysis
- External validation (eICU-CRD)
- Marginal structural models
- Exploratory mediation analysis
Main finding
As reported in the abstract
Vital-sign rhythmicity
- Early high-dose propofol
- β (spectral power, heart rate) 0.033; P < 0.001
- Propofol-to-dexmedetomidine transition
- β (spectral power, heart rate) 0.015; P < 0.001
- Early high-dose propofol
- β (spectral power, temperature) 0.055; P < 0.001
- Propofol-to-dexmedetomidine transition
- β (spectral power, temperature) 0.020; P < 0.001
Observational data: associations, not effects.
Further findings
Delirium (CAM-ICU) mediated via temperature wavelet power (exploratory mediation, Group 2 vs 3)
- Proportion mediated
- 23.5%, 95% CI 16.9-31.0%
- Range across assumptions
- 0% to 34%
- Exploratory
Temperature-derived parameters, eICU-CRD external validation
- Directionally consistent (Cohen's d)
- 0.263 to 0.426
Original publication
Sedation trajectories and circadian rhythm disruption in critically ill adults: an observational cohort study with external validation using MIMIC-IV and eICU-CRD. J Crit Care. Published 30 September 2026. doi:10.
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