Odds for deep sedation high among Hispanic patients with ARDS

Key takeaways:

• Hispanic patients with acute respiratory distress syndrome face elevated odds for deep sedation on ventilation.
• Deep sedation on ventilation was longer in hospitals with vs. without a Hispanic patient.

The likelihood for deep sedation on ventilation was heightened among Hispanic vs. non-Hispanic white patients with acute respiratory distress syndrome, according to results published in Annals of the American Thoracic Society.

Thomas Valley

“Sedation is delivered every day, all-the-time, to pretty much any patient on a ventilator,” Thomas Valley, MD, MSc, associate professor in the division of pulmonary and critical care medicine at University of Michigan, told Healio. “Our findings highlight that, right now, we oversedate nearly all of these patients, and the way we go about delivering sedation may be leading us to particularly oversedate certain groups of patients.”

In a secondary analysis of a multicenter randomized trial, Valley, Mari Armstrong-Hough, PhD, MPH, assistant professor in the departments of social & behavioral sciences and epidemiology at NYU School of Global Public Health, and colleagues assessed 505 ventilated patients with acute respiratory distress syndrome (ARDS) to determine how Hispanic ethnicity is linked to deep sedation exposure through multilevel mixed-effects models.

Mari Armstrong-Hough

“We designed the study because we thought there were many reasons Hispanic-identified patients might be at higher risk of being deeply sedated, including language discordance, disparities in quality of care at minority-serving hospitals and clinician perceptions of patient distress or agitation,” Armstrong-Hough told Healio.

Researchers divided patients based on the presence or absence of at least one Hispanic patient in their hospital and formed a group of 263 patients (median age, 56 years; 52.5% men; 1,094 ventilator-day observations) in a hospital with a Hispanic patient.

A little over half of this cohort identified as non-Hispanic white (55.9%; n = 147), with fewer patients identifying as Hispanic (20.2%; n = 53), non-Hispanic Black (13.7%; n = 36) and non-Hispanic of other races (10.3%; n = 27).

Within the first 5 days of hospitalization, deep sedation was given at least once to nearly every patient (94.3%; n = 248). By day 90, 116 patients (44.1%) had died, according to researchers.

Following adjustment for several characteristics (race, sex, age, BMI, same-day Sequential Organ Failure Assessment score, number of ventilated days, hospital-level clustering and patient-level clustering), researchers found a significantly higher likelihood for deep sedation on ventilation among Hispanic vs. non-Hispanic white patients (adjusted OR = 4.98; 95% CI, 2.02-12.28) on a given day. Armstrong-Hough noted that this was a surprising finding.

“This is a big, big increase in probability of being deeply sedated, even after controlling for clinical factors like severity of illness,” she said.

Between a Hispanic patient and a non-Hispanic white patient, researchers additionally observed that the Hispanic patient has a 19 percentage-point higher probability of deep sedation despite both patients having matching characteristics.

The link between deep sedation and Hispanic ethnicity was further demonstrated when researchers compared the percentage of ventilator days with deep sedation between hospitals with a Hispanic patient (85.8%) and hospitals with no Hispanic patients (65.5%; P < .001).

In terms of deep sedation length, Hispanic patients also had significantly extended periods of this sedation vs. white patients (adjusted increase in absolute risk, 16%; 95% CI, 5.2%-26.8%).

“Now we have one potential mechanism explaining why outcomes are significantly worse for Hispanic patients,” Armstrong-Hough told Healio. “That means future studies can prospectively collect data to evaluate the degree to which it explains higher mortality for this group. Having identified a potential mechanism also means we can begin exploring and evaluating interventions to address overuse of sedation for Hispanic patients.

“I hope to see more intervention-oriented study designs to support clinicians as they try to reduce disparities and deliver the best care for their patients,” she added.

Reference:

• Hispanic patients with respiratory failure much more likely to be oversedated. https://www.nyu.edu/about/news-publications/news/2024/february/respiratory-failure-health-disparities.html. Published Feb. 15, 2024. Accessed Feb. 15, 2024.