An Epidemiologic and Racial Disparity Evaluation of Continuous Infusion Sedation in the Icu

ABSTRACT

INTRODUCTION: Sedative medications are frequently utilized to relieve stress and anxiety, control agitation, and/or improve ventilator synchrony in patients requiring mechanical ventilation. However, many sedative agents have the potential to cause short- and long-term harm. Observational data have described associations between race and negative outcomes in patients with sepsis. It is unclear if race is associated with sedation administration practices. The purpose of this study was to investigate whether Black race is associated with differences in exposure to continuous infusion sedatives compared to White race. METHOD(S) A single-center, retrospective, cohort study was performed in adult patients admitted to the medical or surgical intensive care unit (ICU) with community-onset sepsis between June 1, 2018 and June 1, 2021. Data were collected from the electronic health record. The primary outcome was the cumulative dose of fentanyl received by continuous infusion between day 1-14 of ICU admission. The cumulative doses of other continuous infusion sedatives were described as secondary outcomes. A linear regression model assessed the association of race and the primary outcome while controlling for relevant confounding variables. RESULT(S) 772 patients were included. Black patients had a higher median modified APACHE II score (18 vs. 17, p< 0.001), Charlson Comorbidity Index (4 vs. 3, p=0.003), COVID-19 diagnosis incidence (18.5% vs. 7.1%, p< 0.001), and renal disease incidence (44.9% vs. 27.8%, p< 0.001) at baseline. No difference was observed in the amount of fentanyl received by continuous infusion between day 1-14 of ICU admission between Black and White patients (7085 mcg vs. 6426 mcg, p=0.37). Similarly, no association between Black race and the total amount of propofol (p=0.65), dexmedetomidine (p=0.67), or midazolam (p=0.08) via continuous infusion was observed. A linear regression model observed no significant association between race and the primary outcome. CONCLUSION(S) Black race was not associated with increased exposure to continuous infusion sedatives compared to White race. This is the first known study to investigate racial disparities in sedation strategies in mechanically ventilated adults in the ICU with sepsis.