{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:49Z","timestamp":1792787269848,"version":"4.5.0"},"reference-count":30,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T00:00:00Z","timestamp":1687824000000},"content-version":"unspecified","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Pfizer Korea Pharmaceuticals Ltd","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,6,12]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Changes in sedation levels over a long time in patients who are mechanically ventilated are unknown. Therefore, we investigated the long-term sedation levels of these patients by classifying them into different longitudinal patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This was a multicentre, prospective, longitudinal, and observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Twenty intensive care units (ICUs) spanning several medical institutions in Korea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients who received mechanical ventilation and sedatives in ICU within 48\u2009hours of admission between April 2020 and July 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary objective of this study was to identify the pattern of sedation practice. Additionally, we analysed the associations of trajectory groups with clinical outcomes as the secondary outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sedation depth was monitored using Richmond Agitation-Sedation Scale (RASS). A group-based trajectory model was used to classify 631 patients into four trajectories based on sedation depth: persistent suboptimal (13.2%, RASS \u2264 \u22123 throughout the first 30 days), delayed lightening (13.9%, RASS \u2265 \u22122 after the first 15 days), early lightening (38.4%, RASS \u2265 \u22122 after the first 7\u2009days) and persistent optimal (34.6%, RASS \u2265 \u22122 during the first 30 days). \u2018Persistent suboptimal\u2019 trajectory was associated with delayed extubation (HR: 0.23, 95% CI: 0.16 to 0.32, p&lt;0.001), longer ICU stay (HR: 0.36, 95%\u2009CI: 0.26 to 0.51, p&lt;0.001) and hospital mortality (HR: 13.62, 95%\u2009CI: 5.99 to 30.95, p&lt;0.001) compared with \u2018persistent optimal\u2019. The \u2018delayed lightening\u2019 and \u2018early lightening\u2019 trajectories showed lower extubation probability (HR: 0.30, 95%\u2009CI: 0.23 to 0.41, p&lt;0.001; HR: 0.72, 95%\u2009CI: 0.59 to 0.87, p&lt;0.001, respectively) and ICU discharge (HR: 0.44, 95%\u2009CI: 0.33 to 0.59, p&lt;0.001\u2009and HR: 0.80, 95%\u2009CI: 0.65 to 0.97, p=0.024) compared with \u2018persistently optimal\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among the four trajectories, \u2018persistent suboptimal\u2019 trajectory was associated with higher mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-072628","type":"journal-article","created":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T12:16:21Z","timestamp":1687868181000},"page":"e072628","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Longitudinal trajectories of sedation level and clinical outcomes in patients who are mechanically ventilated based on a group-based trajectory model: a prospective, multicentre, longitudinal and observational study in Korea"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5434-2223","authenticated-orcid":false,"given":"Dong-gon","family":"Hyun","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jee Hwan","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ha-Yeong","family":"Gil","sequence":"additional","affiliation":[{"name":"Medical Research Project Team, Pfizer Korea Pharmaceuticals Ltd, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung Mo","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Choa","family":"Yun","sequence":"additional","affiliation":[{"name":"Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of 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