Association Between Sex and Race and Ethnicity and IV Sedation Use in Patients Receiving Invasive Ventilation
Bibliographic record
Abstract
BACKGROUND: IV sedation is an important tool for managing patients receiving invasive ventilation, yet excess sedation is harmful, and dosing could be influenced by implicit bias.RESEARCH QUESTION: What are the associations between sex or race and ethnicity and sedation practices?STUDY DESIGN AND METHODS: We performed a retrospective single-center cohort study of adults receiving invasive ventilation for $ 24 hours using the Medical Information Mart for Intensive Care Version IV (2008-2019) database from Boston, Massachusetts.We used a repeated-measures design (4-hour intervals) to study the association between sex (female or 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 categorized sedative use as follows: no sedative and then lowest, second, third, and highest quartiles of sedative dose.We adjusted for covariates with multilevel Bayesian proportional odds modeling and reported ORs with 95% credible intervals (CrIs). RESULTS:We studied 6,764 patients: 43% female; 3.5% Asian, 12% Black, 4.5% Hispanic, and 80% White.Benzodiazepines were administered to 2,334 patients (36%).Black patients received benzodiazepines less often and at lower doses than White patients (more benzodiazepine: OR, 0.66; 95% CrI, 0.49-0.92).Propofol was administered to 3,865 patients (57%).Female patients received propofol less often and at lower doses than male patients (more propofol: OR, 0.72; 95% CrI, 0.61-0.86).Dexmedetomidine was administered to 1,439 patients (21%), and use was similar across sex or race and ethnicity.Female patients were less sedated than male patients (deeper sedation: OR, 0.71; 95% CrI, 0.62-0.81),and Black patients were more sedated than White patients (more sedated: OR, 1.28; 95% CrI, 1.05-1.55).INTERPRETATION: Among patients receiving invasive ventilation for at least 24 hours, IV sedation and attained sedation levels varied by sex and by 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 distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".