{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T11:01:33Z","timestamp":1781953293908,"version":"3.54.5"},"reference-count":23,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T00:00:00Z","timestamp":1670198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Excessive sedation is associated with poor outcome in critically ill acute respiratory distress syndrome (ARDS) patients. Whether this prognostic effect varies among ARDS patients with and without COVID-19 has yet to be determined. We compared the prognostic value of excessive sedation\u2014in terms of delirium, length of stay in intensive care unit (ICU-LOS) and ICU mortality\u2014between COVID-19 and non-COVID-19 critically ill ARDS patients. This was a second analysis of prospectively collected data in four European academic centers pertaining to 101 adult critically ill ARDS patients with and without COVID-19 disease. Depth of sedation (DOS) and delirium were monitored through processed electroencephalogram (EEG) and the Confusion Assessment Method for ICU (CAM-ICU). Our main exposure was excessive sedation and how it relates to the presence of delirium, ICU-LOS and ICU mortality. The criterion for excessive sedation was met in 73 (72.3%) patients; of these, 15 (82.2%) and 58 (69.1%) were in non-COVID-19 and COVID-19 ARDS groups, respectively. The criteria of delirium were met in 44 patients (60.3%). Moreover, excessive sedation was present in 38 (86.4%) patients with delirium (p &lt; 0.001). ICU death was ascertained in 41 out of 101 (41.0%) patients; of these, 37 (90.2%) had excessive sedation (p &lt; 0.001). The distribution of ICU-LOS among excessive-sedated and non-sedated patients was 22 (16\u201327) vs. 14 (10.5\u201319.5) days (p &lt; 0.001), respectively. In a multivariable framework, excessive sedation was independently associated with the development of delirium (p = 0.001), increased ICU mortality (p = 0.009) and longer ICU-LOS (p = 0.000), but only in COVID-19 ARDS patients. Independent of age and gender, excessive sedation might represent a risk factor for delirium in COVID-19 ARDS patients. Similarly, excessive sedation shows to be an independent predictor of ICU-LOS and ICU mortality. The use of continuous EEG-based depth of sedation (DOS) monitoring and delirium assessment in critically ill COVID-19 patients is warranted.<\/jats:p>","DOI":"10.3390\/life12122031","type":"journal-article","created":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T04:40:09Z","timestamp":1670215209000},"page":"2031","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Excessive Sedation as a Risk Factor for Delirium: A Comparison between Two Cohorts of ARDS Critically Ill Patients with and without COVID-19"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7187-5168","authenticated-orcid":false,"given":"Frank Anthony","family":"Rasulo","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, 25121 Brescia, Italy"},{"name":"Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7017-0150","authenticated-orcid":false,"given":"Rafael","family":"Badenes","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Cl\u00ednic Universitari, School of Medicine, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8831-1361","authenticated-orcid":false,"given":"Yaroslava","family":"Longhitano","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care Medicine\u2014AON St. Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy"},{"name":"Foundation of \u201cOspedale Alba-Bra Onlus\u201d\u2014Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Racca","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care Medicine\u2014AON St. Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Zanza","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care Medicine\u2014AON St. Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy"},{"name":"Foundation of \u201cOspedale Alba-Bra Onlus\u201d\u2014Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy"},{"name":"Department of Emergency Medicine, Policlinico Gemelli\/IRCCS\u2014University of Catholic of Sacred Heart, 30149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Marchesi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Piva","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Beretta","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Piero","family":"Nocivelli","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil","family":"Matta","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Addenbrookes NHS Hospital, Cambridge University, Cambridge CB39DF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Addenbrookes NHS Hospital, Cambridge University, Cambridge CB39DF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8313-508X","authenticated-orcid":false,"given":"Sergio","family":"Cattaneo","sequence":"additional","affiliation":[{"name":"Division of Cardio-Thoracic Intensive Care, Spedali Civili Hospital, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8679-5435","authenticated-orcid":false,"given":"Gabriele","family":"Savioli","sequence":"additional","affiliation":[{"name":"Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy"},{"name":"PhD Program in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Franceschi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Policlinico Gemelli\/IRCCS\u2014University of Catholic of Sacred Heart, 30149 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Robba","sequence":"additional","affiliation":[{"name":"Policlinico San Martino, Department of Surgical Sciences and Diagnostic Integrated, University of Genoa, 16100 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2521-5871","authenticated-orcid":false,"given":"Nicola","family":"Latronico","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"R30","DOI":"10.1186\/cc8907","article-title":"Intensive Care Unit-acquired infection as a side effect of sedation","volume":"14","author":"Nseir","year":"2010","journal-title":"Crit. 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