Association between sex and race and ethnicity and intravenous sedation use in patients receiving invasive ventilation
crossref(2024)
Abstract
Rationale Intravenous sedation is an important tool for managing invasively ventilated patients, yet excess sedation is harmful, and dosing could be influenced by implicit bias.
Objective To measure the association between sex, race and ethnicity, and sedation practices.
Methods We performed a retrospective cohort study of adults receiving invasive ventilation for 24 hours or more using the MIMIC-IV (2008-2019) database from Boston, USA. We used a repeated-measures design (4-hour time intervals) to study the association between patient sex (female, male) or race and ethnicity (Asian, Black, Hispanic, White) and sedation outcomes. Sedation outcomes included sedative use (propofol, benzodiazepine, dexmedetomidine) and minimum sedation score. We divided sedative use into five categories: no sedative given, then lowest, second, third, and highest quartiles of sedative dose. We used multilevel Bayesian proportional odds modeling to adjust for baseline and time-varying covariates and reported posterior odds ratios with 95% credible intervals [CrI].
Results We studied 6,764 patients: 43% female; 3.5% Asian, 12% Black, 4.5% Hispanic and 80% white. We analyzed 116,519 4-hour intervals. Benzodiazepines were administered to 2,334 (36%) patients. Black patients received benzodiazepines less often and at lower doses than White patients (OR 0.66, CrI 0.49 to 0.92). Propofol was administered to 3,865 (57%) patients. Female patients received propofol less often and at lower doses than male patients (OR 0.72, CrI 0.61 to 0.86). Dexmedetomidine was administered to 1,439 (21%) patients, and use was largely similar across sex or race and ethnicity. As expressed by sedation scores, male patients were more sedated than female patients (OR 1.41, CrI 1.23 to 1.62), and White patients were less sedated than Black patients (OR 0.78, CrI 0.65 to 0.95).
Conclusion Among patients invasively ventilated for at least 24 hours, intravenous sedation and attained sedation levels varied by sex and race and ethnicity. Adherence to sedation guidelines may improve equity in sedation management for critically ill patients.
### Competing Interest Statement
The authors have declared no competing interest.
### Funding Statement
Sarah Walker was funded by the Temerty Centre for AI Research and Education in Medicine Summer Research Studentship. Dr Yarnell was funded by the Canadian Institutes for Health Research Vanier Scholar program, the Eliot Phillipson Clinician Scientist Training Program, and the Clinician Investigator Program of the University of Toronto. Funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; nor in the decision to submit the manuscript for publication. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by any of the funding agencies is intended or should be inferred.
### Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
We used deidentified patient data from the Medical Information Mart for Intensive Care version IV (MIMIC-IV) database. It contains intensive care unit (ICU) admissions from an academic quaternary centre in Boston, USA, between 2008 and 2019. It is approved for database research by the Beth Israel Deaconess Medical Center (2001-P-001699/14) and the Massachusetts Institute of Technology (0403000206). MIMIC-IV is available from .
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as [ClinicalTrials.gov][1]. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Yes
All data are available online at .
.
[1]: http://ClinicalTrials.gov
MoreTranslated text
AI Read Science
Must-Reading Tree
Example
![](https://originalfileserver.aminer.cn/sys/aminer/pubs/mrt_preview.jpeg)
Generate MRT to find the research sequence of this paper
Chat Paper
Summary is being generated by the instructions you defined