Association between sex and race and ethnicity and intravenous sedation use in patients receiving invasive ventilation
Bibliographic record
Abstract
Abstract Rationale Intravenous sedation is an important tool for managing invasively ventilated patients, yet excess sedation is harmful, and dosing could be influenced by implicit bias. Objective To measure the association between sex, race and ethnicity, and sedation practices. Methods We performed a retrospective cohort study of adults receiving invasive ventilation for 24 hours or more using the MIMIC-IV (2008-2019) database from Boston, USA. We used a repeated-measures design (4-hour time intervals) to study the association between patient sex (female, male) or race and ethnicity (Asian, Black, Hispanic, White) and sedation outcomes. Sedation outcomes included sedative use (propofol, benzodiazepine, dexmedetomidine) and minimum sedation score. We divided sedative use into five categories: no sedative given, then lowest, second, third, and highest quartiles of sedative dose. We used multilevel Bayesian proportional odds modeling to adjust for baseline and time-varying covariates and reported posterior odds ratios with 95% credible intervals [CrI]. Results We studied 6,764 patients: 43% female; 3.5% Asian, 12% Black, 4.5% Hispanic and 80% white. We analyzed 116,519 4-hour intervals. Benzodiazepines were administered to 2,334 (36%) patients. Black patients received benzodiazepines less often and at lower doses than White patients (OR 0.66, CrI 0.49 to 0.92). Propofol was administered to 3,865 (57%) patients. Female patients received propofol less often and at lower doses than male patients (OR 0.72, CrI 0.61 to 0.86). Dexmedetomidine was administered to 1,439 (21%) patients, and use was largely similar across sex or race and ethnicity. As expressed by sedation scores, male patients were more sedated than female patients (OR 1.41, CrI 1.23 to 1.62), and White patients were less sedated than Black patients (OR 0.78, CrI 0.65 to 0.95). Conclusion Among patients invasively ventilated for at least 24 hours, intravenous sedation and attained sedation levels varied by sex and race and ethnicity. Adherence to sedation guidelines may improve equity in sedation management for critically ill patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".