Table 4 Primary and secondary outcomes stratified by risks
Variable | No protocol | CPOE protocol | Revised CPOE protocol | P-Value | P-Value | P-Value |
|---|---|---|---|---|---|---|
(n = 91) | (n = 97) | (n = 91) | 1 vs. 2 | 2 vs. 3 | 1 vs. 3 | |
Risk 1 patients: age ˂60 years, normal kidney function (MDRD ˃90), normal liver function (MELD ˂8) | ||||||
Primary outcomes | ||||||
Mechanical ventilation duration, mean ± SD, days | 5.9 ± 6.4 | 12.2 ± 12.2 | 10.5 ± 9.4 | 0.21 | 0.55 | 0.40 |
ICU LOS, mean ± SD, days | 10.3 ± 7.4 | 13.3 ± 15.2 | 12.2 ± 11.5 | 0.39 | 0.75 | 0.44 |
Hospital LOS, mean ± SD, days | 78.4 ± 95.4 | 52.3 ± 53.5 | 50.8 ± 56.6 | 0.25 | 0.92 | 0.22 |
ICU mortality, n (%) | 3 (13) | 3 (13) | 4 (11) | 1 | 1 | 1 |
Hospital mortality, n (%) | 5 (21) | 5 (21) | 4 (11) | 1 | 0.46 | 0.46 |
Secondary outcomes | ||||||
Average daily doses of analgesics and sedatives | ||||||
Fentanyl, mean ± SD, mcg/day | 3694 ± 2315 | 3711 ± 2879 | 2613 ± 2257 | 0.98 | 0.11 | 0.08 |
Morphine, mg/day | 2.2 ± 9.3 | 0.93 ± 3.8 | 1.09 ± 3.4 | 0.54 | 0.87 | 0.58 |
Dexmedetomidine, mean ± SD mcg/day | 52 ± 112 | 125 ± 269 | 42 ± 93 | 0.23 | 0.16 | 0.72 |
Midazolam, mean ± SD, mg/day | 158 ± 148 | 111 ± 132 | 98 ± 113 | 0.26 | 0.67 | 0.08 |
Propofol, mean ± SD, mg/day | 564 ± 947 | 812 ± 1517 | 643 ± 1063 | 0.50 | 0.62 | 0.77 |
Lorazepam, mg/day | 0.17 ± 0.52 | 0.10 ± 0.31 | 0 ± 0 | 0.58 | - | - |
Haloperidol, mg/day | 0.17 ± 0.49 | 0.90 ± 2.8 | 0.37 ± 1.19 | 0.22 | 0.39 | 0.37 |
Paralytics, mg/day | 50.3 ± 85.4 | 47.3 ± 104.2 | 30.5 ± 59.7 | 0.91 | 0.48 | 0.30 |
Average NRS, SAS and GCS scores | ||||||
NRS score, mean ± SD | 0.28 ± 0.54 | 0.22 ± 0.4 | 1.01 ± 0.86 | 0.63 | <0.0001 | 0.0002 |
SAS Score, mean ± SD | 2.2 ± 1.1 | 2.5 ± 1.1 | 2.5 ± 1.3 | 0.47 | 0.96 | 0.46 |
GCS score, mean ± SD | 6.4 ± 3.4 | 6.9 ± 3.4 | 7 ± 3.3 | 0.58 | 0.95 | 0.50 |
Sedation-related complications during ICU stay | ||||||
Agitated (SAS = 5), n (%) | 7 (29.2) | 9 (37.5) | 0 (0) | 0.54 | <0.0001 | 0.001 |
Very agitated (SAS = 6), n (%) | 3 (12.5) | 2 (8.3) | 1 (2.9) | 1.00 | 0.56 | 0.29 |
Dangerous agitation (SAS = 7), n (%) | 2 (8.3) | 1 (4.2) | 0 (0) | 100 | 0.41 | 0.16 |
NGT self-removal, n (%) | 1 (4.2) | 0 (0) | 0 (0) | 1.00 | - | 0.41 |
ETT self-removal, n (%) | 0 (0) | 0 (0) | 0 (0) | - | - | - |
Brain CT scans for mental status assessment, n (%) | 0 (0) | 0 (0) | 0 (0) | - | - | - |
Risk 2 patients: age = 60–70 years, moderate kidney function impairment (MDRD = 30–90), moderate liver function impairment (MELD = 8–14) | ||||||
Primary outcomes | ||||||
Mechanical ventilation duration, mean ± SD, days | 9.6 ± 8.2 | 12.7 ± 13.8 | 8.4 ± 6.0 | 0.40 | 0.22 | 0.64 |
ICU LOS, mean ± SD, days | 11.3 ± 8.6 | 13 ± 12.1 | 11.4 ± 12.3 | 0.64 | 0.72 | 0.97 |
Hospital LOS, mean ± SD, days | 70.8 ± 95.3 | 45.3 ± 27.6 | 53.3 ± 42.2 | 0.29 | 0.51 | 0.49 |
ICU mortality, n (%) | 2 (11) | 2 (11) | 2 (13) | 1 | 1 | 1 |
Hospital mortality, n (%) | 3 (17) | 2 (11) | 3 (19) | 0.66 | 0.64 | 0.87 |
Secondary outcomes | ||||||
Average daily doses of analgesics and sedatives | ||||||
Fentanyl, mean ± SD mcg/day | 2336 ± 1979 | 4153 ± 3967 | 2759 ± 2455 | 0.09 | 0.23 | 0.58 |
Morphine, mg/day | 0.19 ± 0.59 | 0.02 ± 0.07 | 0.15 ± 0.42 | 0.23 | 0.22 | 0.83 |
Dexmedetomidine, mean ± SD mcg/day | 47 ± 67 | 54 ± 119 | 60 ± 214 | 0.82 | 0.92 | 0.81 |
Midazolam, mean ± SD mg/day | 59 ± 75 | 91 ± 88 | 98 ± 122 | 0.24 | 0.85 | 0.26 |
Propofol, mean ± SD mg/day | 201 ± 326 | 118 ± 285 | 759 ± 1425 | 0.42 | 0.1 | 0.14 |
Lorazepam, mg/day | 0.75 ± 0.23 | 0.02 ± 0.07 | 0 ± 0 | 0.36 | - | - |
Haloperidol, mg/day | 0.92 ± 1.58 | 0.26 ± 0.61 | 0.14 ± 0.56 | 0.11 | 0.55 | 0.06 |
Paralytics, mg/day | 6.0 ± 14.4 | 5.4 ± 14.6 | 25.9 ± 57.7 | 0.90 | 0.19 | 0.20 |
Average NRS, SAS and GCS scores | ||||||
NRS score, mean ± SD | 0.44 ± 0.80 | 0.23 ± 0.53 | 0.93 ± 0.69 | 0.35 | 0.002 | 0.06 |
SAS score, mean ± SD | 3.1 ± 0.9 | 2.8 ± 1.0 | 2.3 ± 1.2 | 0.42 | 0.24 | 0.055 |
GCS score, mean ± SD | 7.7 ± 2.2 | 8.2 ± 4.0 | 6.4 ± 3 | 0.64 | 0.13 | 0.14 |
Sedation-related complications during ICU stay | ||||||
Agitated (SAS = 5), n (%) | 10 (55.6) | 9 (47.4) | 0 (0) | 0.62 | 0.001 | 0.0004 |
Very agitated (SAS = 6), n (%) | 3 (16.7) | 1 (5.3) | 0 (0) | 0.34 | 1.00 | 0.23 |
Dangerous agitation (SAS = 7), n (%) | 1 (5.6) | 0 (0) | 0 (0) | 0.49 | - | 1.00 |
NGT self-removal, n (%) | 1 (5.6) | 2 (10.5) | 0 (0) | 1.00 | 0.49 | 1.00 |
ETT self-removal, n (%) | 0 (0) | 0 (0) | 0 (0) | - | - | - |
Brain CT scans for mental status assessment, n (%) | 0 (0) | 0 (0) | 0 (0) | - | - | - |
Risk 3 patients: age ˃70 years, severe kidney function impairment (MDRD ˂30), severe liver function impairment (MELD ˃14) | ||||||
Primary outcomes | ||||||
Mechanical ventilation duration, mean ± SD, days | 11.3 ± 10.0 | 11.8 ± 9.0 | 10.9 ± 7.1 | 0.81 | 0.61 | 0.82 |
ICU LOS, mean ± SD, days | 13.2 ± 11.6 | 12 ± 9.9 | 13.6 ± 9.5 | 0.56 | 0.42 | 0.86 |
Hospital LOS, mean ± SD, days | 52.5 ± 75.4 | 33 ± 29.8 | 39.1 ± 22.7 | 0.10 | 0.28 | 0.25 |
ICU mortality, n (%) | 19 (39) | 33 (61) | 10 (25) | 0.02 | 0.0005 | 0.17 |
Hospital mortality, n (%) | 28 (57) | 36 (67) | 22 (55) | 0.32 | 0.25 | 0.84 |
Secondary outcomes | ||||||
Average daily doses of analgesics and sedatives | ||||||
Fentanyl, mean ± SD mcg/day | 2232 ± 2108 | 3571 ± 3245 | 1633 ± 1719 | 0.01 | 0.0003 | 0.15 |
Morphine, mg/day | 0.14 ± 0.82 | 0.23 ± 1.3 | 0 ± 0 | 0.68 | 0.19 | 0.24 |
Dexmedetomidine, mean ± SD mcg/day | 46 ± 130 | 12 ± 51 | 32 ± 102 | 0.10 | 0.28 | 0.57 |
Midazolam, mean ± SD mg/day | 55 ± 71 | 58 ± 84 | 30 ± 42 | 0.85 | 0.03 | 0.04 |
Propofol, mean ± SD mg/day | 148 ± 508 | 90 ± 240 | 293 ± 523 | 0.48 | 0.03 | 0.19 |
Lorazepam, mg/day | 0.05 ± 0.18 | 0.05 ± 0.28 | 0 ± 0 | 0.99 | - | - |
Haloperidol, mg/day | 0.08 ± 0.43 | 0.27 ± 1.41 | 0.13 ± 0.51 | 0.34 | 0.51 | 0.58 |
Paralytics, mg/day | 25.8 ± 54.8 | 12.8 ± 35.8 | 12.0 ± 32.6 | 0.17 | 0.91 | 0.15 |
Average NRS, SAS and GCS scores | ||||||
NRS score, mean ± SD | 0.15 ± 0.27 | 0.11 ± 0.25 | 1.07 ± 0.61 | 0.46 | <0.0001 | <0.0001 |
SAS score, mean ± SD | 2.3 ± 1.1 | 2.1 ± 1.0 | 2.6 ± 1.0 | 0.31 | 0.02 | 0.18 |
GCS score, mean ± SD | 6.5 ± 3.2 | 5.9 ± 2.9 | 7.4 ± 2.6 | 0.32 | 0.01 | 0.17 |
Sedation-related complications during ICU stay | ||||||
Agitated (SAS = 5), n (%) | 20 (40.8) | 11 (20.4) | 3 (7.5) | 0.02 | 0.08 | 0.0004 |
Very agitated (SAS = 6), n (%) | 4 (8.2) | 3 (5.6) | 2 (5) | 0.71 | 1.00 | 0.69 |
Dangerous agitation (SAS = 7), n (%) | 1 (2) | 0 (0) | 2 (5) | 0.48 | 0.18 | 0.59 |
NGT self-removal, n (%) | 0 (0) | 0 (0) | 0 (0) | - | - | - |
ETT self-removal, n (%) | 2 (4.1) | 0 (0) | 0 (0) | 0.22 | - | 0.50 |
Brain CT scans for mental status assessment, n (%) | 1 (2) | 0 (0) | 0 (0) | 0.48 | - | 1.00 |