Initial sedation strategy and clinical outcomes in mechanically ventilated neurocritical care patients with acute brain injury: a retrospective cohort study

Abstract

Background Sedation is a cornerstone in the management of neurocritical care patients with brain injuries. However, optimal sedation practices remain controversial. This study aims to evaluate the association between initial sedation strategies and key clinical outcomes, including duration of mechanical ventilation, ICU length of stay, extubation success, and mortality. Methods This retrospective observational study analyzed 147 adult patients with acute brain injury admitted to neurocritical care units. Eligible patients received invasive mechanical ventilation (IMV) for ≥24 h and underwent at least one weaning attempt. Sedation agents assessed included propofol, midazolam, combined regimens, dexmedetomidine, sodium thiopental and no sedation. Data on demographics, comorbidities, ventilation parameters, and outcomes were extracted and analyzed using SPSS v27. Regression models evaluated the impact of sedation type on clinical outcomes. Results This study included 147 critically ill patients. Sedation practices shifted over time, with propofol use decreasing from 46.2% on Day 1 to 26.3% on Day 7, while the proportion of patients receiving no sedation increased to 38.7%. Hospital interventions, including use of ICP monitors and ventilation strategies, varied significantly across sedation groups. Combined sedation and no sedation groups had significantly prolonged mechanical ventilation and ICU stays. Regression analysis showed that compared to propofol, combined sedation was associated with increased IMV days (B = 3.470, p < 0.001), ICU stay (B = 5.501, p < 0.001), and delayed extubation (B = 5.662, p < 0.001). Midazolam and no-sedation groups showed variable associations across outcomes. These findings highlight the impact of sedation strategy on patient recovery and ICU resource utilization. Conclusion Sedation strategy significantly influences clinical aspects in neurocritical care. Propofol appears superior for facilitating faster recovery, while midazolam and combined use are linked to adverse outcomes. Individualized, protocol-driven sedation approaches are essential to optimize care for patients with acute brain injury.