{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T07:03:41Z","timestamp":1789715021676,"version":"4.0.1"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long\u2010term psychological impairment is a major concern for intensive care unit (ICU) survivors. Early deep sedation during mechanical ventilation has been associated with poor short\u2010term outcomes and mortality after ICU discharge; however, its relationship with psychological outcomes remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To investigate sedation intensity during the first 24\u2009h of mechanical ventilation and its association with psychological impairment 3 months after ICU discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>This retrospective ancillary analysis of a single\u2010centre cohort study was conducted in two general ICUs at a university hospital in Japan. Eligible patients stayed in the ICU for more than 48\u2009h and received mechanical ventilation for more than 8\u2009h. Sedation intensity was quantified using the Sedation Index (SI) and Agitation Index (AI) derived from Richmond Agitation\u2010Sedation Scale scores during the first 24\u2009h. Psychological impairment 3 months post\u2010ICU discharge was assessed based on symptoms of post\u2010traumatic stress, anxiety and depression. Associations were examined using hierarchical logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 130 participants, the median age was 64\u2009years, and the median ventilation duration was 14\u2009h. The median SI was 3.0; 47% had SI &gt;\u20093, and 8.5% had AI &gt;\u20090. Sedation intensity showed no significant association with psychological impairment (SI: adjusted odds ratio [OR] 0.87, 90% confidence interval [CI] 0.57\u20131.33,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.59; AI: adjusted OR 0.21, 90% CI 0.01\u20133.08,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.34). However, any agitation during the ICU stay was associated with psychological outcomes (adjusted OR 2.61, 90% CI 1.16\u20135.88,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study did not identify a statistically significant association between early sedation intensity and psychological impairment 3 months after ICU discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>Critical care nurses should carefully titrate sedation from the initiation of mechanical ventilation to avoid unnecessary deep sedation, considering sedation intensity over time, while actively assessing agitation and its underlying causes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70500","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T01:46:22Z","timestamp":1777427182000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Sedation Intensity and Psychological Outcomes in Critically Ill Adults"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7134-1168","authenticated-orcid":false,"given":"Mikiko","family":"Iwatani","sequence":"first","affiliation":[{"name":"Okayama University Hospital; Graduate School of Health Sciences, Doctoral Program Okayama University  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6441-8671","authenticated-orcid":false,"given":"Michiko","family":"Morimoto","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences Okayama University  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000882"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2016.08.005"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000001811"},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-018-2223-6"},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318232da75"},{"key":"e_1_2_16_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0252167"},{"key":"e_1_2_16_8_1","doi-asserted-by":"publisher","DOI":"10.5630\/jans.41.414"},{"key":"e_1_2_16_9_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200505-693OC"},{"key":"e_1_2_16_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003299"},{"key":"e_1_2_16_11_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201203-0522OC"},{"key":"e_1_2_16_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002885"},{"key":"e_1_2_16_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003071"},{"key":"e_1_2_16_14_1","doi-asserted-by":"publisher","DOI":"10.47102\/annals-acadmed.sg.202013"},{"key":"e_1_2_16_15_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"key":"e_1_2_16_16_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2107138"},{"key":"e_1_2_16_17_1","first-page":"168","volume-title":"Assessing Psychological Trauma and PTSD","author":"Weiss D. 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