Abstract Rationale Sedation management in mechanically ventilated ICU patients is crucial, yet patterns of sedation and their relationship with patient outcomes are not fully understood. This study aimed to identify and characterize distinct sedation trajectory classes in a large cohort of mechanically ventilated ICU patients, providing a foundation for understanding how sedation practices influence clinical outcomes. Methods We conducted a retrospective cohort study using electronic health record data from 3,902 mechanically ventilated ICU patients between 2020 and 2025. We applied group-based trajectory modeling (GBTM) to repeated Richmond Agitation-Sedation Scale (RASS) assessments taken every 8 hours over the first 72 hours of mechanical ventilation. The optimal number of trajectory classes was determined using the Bayesian Information Criterion (BIC). We characterized the identified classes based on patient demographics, illness severity (APACHE II, SOFA), and sedation medication usage. Results We identified five distinct sedation trajectory classes with excellent model fit (Average Posterior Probability 0.75 for all classes). The classes were: Class 1: Deep to Moderate Sedation (5.2%), characterized by a rapid deepening of sedation; Class 2: Deep Sedation with Awakening (6.9%), showing a pattern of deep sedation followed by gradual awakening; Class 3: Light Sedation (55.8%), representing a majority of patients maintained at a light level of sedation; Class 4: Deep to Alert (18.1%), with patients starting deeply sedated and rapidly awakening; and Class 5: Persistently Deep Sedation (14.0%), where patients remained deeply sedated throughout the observation period. Patients in Class 5 had the highest illness severity (mean APACHE II 23.6) and mortality (46.8%), while Class 4 had the lowest mortality (19.5%). Conclusions Our study identified five distinct and clinically meaningful sedation trajectories in mechanically ventilated ICU patients. These findings highlight the heterogeneity of sedation practices and suggest that specific sedation patterns, particularly persistent deep sedation, are associated with higher illness severity and mortality. These trajectory classes provide a novel framework for future research on the impact of sedation on patient outcomes. This abstract is funded by: 5T32GM095442-13, UL1TR002378
Malik et al. (Fri,) studied this question.
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