Associations between different sedatives and ventilator-associated events, length-of-stay, and mortality in mechanically ventilated XXXX .

@entity1 @entity551 @entity1245 @entity1875 @entity6948 @entity204 @entity221
Background: Current sedation guidelines recommend avoiding @entity1245 but express no preference for @entity1875 versus @entity6948 . In addition, there are limited data on how well randomized controlled trials on sedatives generalize to routine practice where conditions tend to be more varied and complex. Methods: We gathered daily sedative exposure data from all @entity1 on mechanical ventilation for >= 3 days over a 7-year period in a large academic medical center. We compared hazard ratios for ventilator-associated events (VAEs), extubation, hospital discharge, and @entity204 amongst @entity1245 , @entity1875 , and @entity6948 using proportional subdistribution hazard models with competing risks. We adjusted all analyses for ICU type, demographics, comorbidities, procedures, severity of @entity221 , @entity551 , oxygenation, renal function, opioids, neuroleptics, neuromuscular blockers, awakening and breathing trials, and calendar year. Results: We evaluated 9,603 consecutive episodes of mechanical ventilation. @entity1245 and @entity1875 were associated with increased VAE risk whereas @entity6948 was not. @entity1875 was associated with less time to extubation compared to @entity1245 (HR for extubation 1.4, 95% CI 1.3-1.5). @entity6948 was associated with less time to extubation compared to both @entity1245 (HR 2.3, 95% CI 2.0-2.7) and @entity1875 (HR 1.7, 95% CI 1.4-2.0) but there were relatively few @entity6948 exposures available for analysis. There were no differences between any two agents in hazards for hospital discharge or mortality. Conclusions: In this large, real-world cohort, @entity1875 and @entity6948 were associated with less time to extubation compared to @entity1245 but @entity6948 was also associated with less time to extubation compared to @entity1875 . These possible differences merit further study.
