Association of early sedation level with patient outcomes in moderate-to-severe acute respiratory distress syndrome: Propensity-score matched analysis

J Crit Care. 2022 Oct:71:154118. doi: 10.1016/j.jcrc.2022.154118. Epub 2022 Jul 26.


Purpose: Studies of early depth of sedation in mixed critically ill populations have suggested benefit to light sedation; however, the relationship of early depth of sedation with outcomes in patients with acute respiratory distress syndrome (ARDS) is unknown.

Materials and methods: We performed a propensity-score matched analysis of early light sedation (Richmond Agitation Sedation Scale Score, RASS 0 to -1 or equivalent) versus deep sedation (RASS -2 or lower) in patients enrolled in the non-intervention group of The Reevaluation of Systemic Early Neuromuscular Blockade trial. Primary outcome was 90 day mortality. Secondary outcomes included days free of mechanical ventilation, days not in ICU, days not in hospital at day 28.

Results: 137 of 486 participants (28.2%) received early light sedation. Vasopressor usage and Apache III scores significantly differed between groups. Prior to matching, 90-day mortality was higher in the early deep sedation (45.3%) compared to light sedation (34.2%) group. In the propensity score matched cohort, there was no difference in 90-day mortality (Odds Ratio (OR) 0.72, 95% CI 0.41, 1.27, p = 0.26) or secondary outcomes between the groups.

Conclusions: We did not find an association between early depth of sedation and clinical outcomes in this cohort of patients with moderate-to-severe ARDS.

Keywords: Acute respiratory distress syndrome; Propensity score; Sedation.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Humans
  • Hypnotics and Sedatives* / therapeutic use
  • Intensive Care Units
  • Propensity Score
  • Respiration, Artificial / adverse effects
  • Respiratory Distress Syndrome* / therapy


  • Hypnotics and Sedatives