Impact of a Nurse-Led, Target-Directed Light Sedation Strategy on the Incidence of Delirium in Septic Patients in the Emergency Intensive Care Unit

Objective To evaluate the impact of a nurse-led, target-directed light sedation strategy on delirium incidence and short-term outcomes in septic patients undergoing invasive mechanical ventilation in the emergency intensive care unit (EICU). Methods We analyzed 221 consecutive septic patients requiring invasive mechanical ventilation for more than 24 h at a single center (January 2022–May 2024). Based on a sedation protocol change, patients were assigned to conventional sedation group (control, n = 123) or nurse-led, target-directed light sedation group (exposed, n = 98). The primary outcome was delirium incidence. Secondary outcomes included delirium-free days (DFD-28), ventilator-free days (VFD-28), mechanical ventilation duration, EICU length of stay, and 28-day mortality. Multivariable logistic regression examined the independent association between the nurse-led strategy and delirium risk. Results Delirium occurred less frequently in the nurse-led sedation group than in the control group (20.4% vs 37.4%, P = .007). The exposed group had shorter mechanical ventilation duration and EICU length of stay (both P < .05), whereas VFD-28 did not differ significantly between groups. The two groups did not differ significantly in 28-day mortality (28.6% vs 26.0%, P = .671) or in the rate of airway-related adverse events. On multivariable analysis, the nurse-led strategy was independently associated with a lower risk of delirium ( OR = 0.428, 95% CI : 0.215-0.854, P = .016). Subgroup analyses showed that this protective benefit was consistent across age strata, disease severity levels, and comorbidity burden. Conclusion In septic patients undergoing mechanical ventilation, a nurse-led, target-directed light sedation strategy was associated with reduced delirium incidence, shorter mechanical ventilation duration, and decreased EICU length of stay, without increasing adverse events. However, no improvement in 28-day mortality was observed. Further validation through multicenter prospective randomized controlled trials is warranted to assess long-term efficacy and safety.