In Reply: Sedation choices and mortality: a well-defined tandem?
In Reply: Sedation choices and mortality: a well‑defined tandem?
Kenshi Hayashida 0 1 2
Masaji Nishimura 0 1 2
Yuichi Imanaka 0 1 2
To the Editor: 0 1 2
0 Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine , Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501 , Japan
1 Department of Emergency and Critical Care Medicine, Tokushima University Graduate School , 3-18-15, Kuramoto-cho, Tokushima 770-8503 , Japan
2 Department of Medical Informatics and Management, University Hospital, University of Occupational and Environmental Health , 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8556 , Japan
Propofol; Benzodiazepines; Mechanical ventilation; Administrative data
We wish to thank Dr. Jiang et al. for their thoughtful
comments  on our recent work .
Several reasons may explain the difference in findings
on mortality between our study and the meta-analysis by
Fraser et al. . One possibility is the fundamental
difference in data source: while the meta-analysis involved
pooled data from six papers, our study used a multi-center
database. Next, the meta-analysis utilized
Mantel–Haenszel risk ratios for short-term mortality, whereas our study
employed a Cox proportional hazards analysis for
in-hospital mortality. Moreover, the meta-analysis compared
mortality between patients who had been administered
benzodiazepines and nonbenzodiazepines, while our study
focused on those who had been administered only
benzodiazepines or propofol. Any or all of these factors may have
contributed to the conflicting results.
We agree that sedation depth is a potentially important
element in the relationship between sedative drugs and
patient outcome, but were unable to incorporate this
factor due to a lack of relevant information, such as Richmond
Agitation-Sedation Scale. Nevertheless, it may be possible
to collect additional information on drug usage for
integration into current data. The inclusion of sedation depth is a
worthwhile consideration for future studies.
Compliance with ethical standards
Conflict of interest None.
1. Jiang C , Esquinas AM , Mina B. Sedation choices and mortality: a well-defined tandem ? J Anesth . 2016 ; 30 : 918 .
2. Hayashida K , Umegaki T , Ikai H , Murakami G , Nishimura M , Imanaka Y. The relationship between sedative drug utilization and outcomes in critically ill patients undergoing mechanical ventilation . J Anesth . 2016 ; 30 : 763 - 9 .
3. Fraser GL , Devlin JW , Worby CP , Alhazzani W , Barr J , Dasta JF , Kress JP , Davidson JE , Spencer FA . Benzodiazepine versus nonbenzodiazepine-based sedation for mechanically ventilated, critically ill adults: a systematic review and meta-analysis of randomized trials . Crit Care Med . 2013 ; 41 : S30 - 8 .