Sedation and renal impairment in critically ill patients: a post hoc analysis of a randomized trial.
Strom T, Johansen RR, Prahl JO, Toft P.
Crit Care. 2011 May 4;15(3):R119. [Epub ahead of print]
Abstract
INTRODUCTION: Not sedating critically ill patients reduces the time patients receive mechanical ventilation, decreases the time in the intensive care department and reduces the total hospital length of stay. We hypothesized that no sedation improves hemodynamic stability, decreases the need for vasoactive drugs, diminishes the need for extra fluids and lowers the risk of acute kidney injury. METHODS: We performed an evaluation on the database from our previous trial of 140 patients randomized to either no sedation vs. sedation with a daily interruption of sedatives (ClinicalTrials.gov number NCT00466492). 113 patients were included in the previous statistical analysis. 10 patients had pre-existing renal impairments and were excluded. Data was collected from observational cards and blood samples. RESULTS:
A total of 103 patients were included in this retrospective review. We registered an increased urine output in the group receiving no sedation compared to the sedated control group (1.15 ml/kg/hour (0.59 - 1.53) vs. 0.88 ml/kg/hour (0.052 - 1.26), P = 0.03). In addition we saw a decrease in the number of patients with renal impairment according to the RIFLE classification in the group receiving no sedation compared to the sedated control group (25 (51%) vs. 41 (76%), P = 0.012). The difference in the two groups with respect to mean arterial blood pressure, fluid balance and use of vasoactive drugs was not significant. CONCLUSIONS: A no sedation strategy to patients undergoing mechanical ventilation increases the urine output and decreases the number of patients with renal impairments. Trial registration: ClinicalTrials.gov registration number NCT00466492
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