Selection strategy for sedation depth in critically ill patients on mechanical ventilation

BMC Medical Informatics and Decision Making

Bo Tang¹  Longxiang Su¹  Xiang Zhou¹  Yun Long¹  Na Hong²  Lin Han²  Fengxiang Chang²  Chun Liu²  Huizhen Jiang³  Weiguo Zhu⁴ 

[1]Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China

[2]Digital Health China Technologies Co. Ltd., Floor 19, China Technology Exchange Building, 66 West Beisihuan Road, Haidian District, 100080, Beijing, China

[3]Information Center Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China

[4]Information Center Department/Department of Information Management, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China

关键词: Mechanical ventilation;    Clustering;    Sedation and analgesia;    Latent profile analysis;    ICU;   

DOI  :  10.1186/s12911-021-01452-7

来源: Springer

【 摘 要 】

BackgroundAnalgesia and sedation therapy are commonly used for critically ill patients, especially mechanically ventilated patients. From the initial nonsedation programs to deep sedation and then to on-demand sedation, the understanding of sedation therapy continues to deepen. However, according to different patient’s condition, understanding the individual patient’s depth of sedation needs remains unclear.MethodsThe public open source critical illness database Medical Information Mart for Intensive Care III was used in this study. Latent profile analysis was used as a clustering method to classify mechanically ventilated patients based on 36 variables. Principal component analysis dimensionality reduction was used to select the most influential variables. The ROC curve was used to evaluate the classification accuracy of the model.ResultsBased on 36 characteristic variables, we divided patients undergoing mechanical ventilation and sedation and analgesia into two categories with different mortality rates, then further reduced the dimensionality of the data and obtained the 9 variables that had the greatest impact on classification, most of which were ventilator parameters. According to the Richmond-ASS scores, the two phenotypes of patients had different degrees of sedation and analgesia, and the corresponding ventilator parameters were also significantly different. We divided the validation cohort into three different levels of sedation, revealing that patients with high ventilator conditions needed a deeper level of sedation, while patients with low ventilator conditions required reduction in the depth of sedation as soon as possible to promote recovery and avoid reinjury.ConclusionThrough latent profile analysis and dimensionality reduction, we divided patients treated with mechanical ventilation and sedation and analgesia into two categories with different mortalities and obtained 9 variables that had the greatest impact on classification, which revealed that the depth of sedation was limited by the condition of the respiratory system.

【 授权许可】

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