Ethnic Disparities in Deep Sedation of Patients with Acute Respiratory Distress Syndrome in the United States: Secondary Analysis of a Multicenter Randomized Trial
Abstract
RATIONALE
Patients identified as Hispanic, the largest minority group in the United States (U.S.), are more likely to die from acute respiratory distress syndrome (ARDS) than non-Hispanic patients. Mechanisms to explain this disparity remain unidentified. However, Hispanic patients may be at risk of overexposure to deep sedation due to language differences between patients and clinicians, and deep sedation is associated with higher ARDS mortality.
OBJECTIVE
We examined associations between Hispanic ethnicity and exposure to deep sedation among patients with ARDS.
METHODS
A secondary analysis was conducted of patients enrolled in the control arm of a randomized trial of neuromuscular blockade for ARDS across 48 U.S. hospitals. Exposure to deep sedation was measured over the first five days that a patient was alive and received mechanical ventilation. Multilevel mixed-effects models were used to evaluate associations between Hispanic ethnicity and exposure to deep sedation, controlling for patient characteristics.
RESULTS
Patients identified as Hispanic had approximately five times the odds of deep sedation (OR 4.98, 95%CI 2.02-12.28, p<0.0001) on a given day compared to non-Hispanic White patients. Hospitals with at least one enrolled Hispanic patient kept all enrolled patients deeply sedated longer than hospitals without any enrolled Hispanic patients (85.8% of ventilator-days vs 65.5%, p<0.001).
CONCLUSIONS
Hispanic patients are at higher risk of exposure to deep sedation…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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