Association of nurse-led targeted sedation-analgesia management with ventilation duration and sedation quality in mechanically ventilated patients

Abstract

Purpose Variability in sedation–analgesia assessment and titration is common in mechanically ventilated ICU patients and may contribute to unnecessary deep sedation and delayed ventilator liberation. This study examined the association between a nurse-led targeted sedation-analgesia management workflow and clinical outcomes in an Intensive Care Unit (ICU). Methods This single-center retrospective observational cohort study was conducted and reported in accordance with the STROBE statement. Adult patients receiving invasive mechanical ventilation for ≥24 hours in the ICU from January 1, 2024 to December 31, 2025 were included. Patients were classified into a usual-care group (physician-directed care) or a nurse-led targeted management group using prespecified documentation-based operational criteria, including daily RASS targets, assessment frequency, nurse-driven titration, and closed-loop reassessment. Primary outcomes were duration of invasive mechanical ventilation and sedation target attainment (proportion of RASS assessments within target). Secondary outcomes included deep sedation exposure (RASS ≤ −3), agitation exposure (RASS ≥ +1), ICU length of stay, delirium, unplanned extubation, reintubation within 48 hours, tracheostomy, and 28-day mortality. Results A total of 102 patients were analyzed (usual-care group, n = 48; nurse-led group, n = 54). The nurse-led group had shorter mechanical ventilation duration (4.3 [3.2–6.3] vs 5.9 [4.3–8.7] days; P < 0.01) and higher sedation target attainment (74.0% ± 11.5% vs 61.5% ± 12.8%; P < 0.01). Deep sedation exposure and agitation exposure were lower in the nurse-led group (16.1% ± 9.1% vs 27.6% ± 10.9%; P < 0.01, and 9.1% ± 6.0% vs 12.4% ± 7.3%; P = 0.03, respectively), and ICU length of stay was shorter (8.0 ± 4.2 vs 9.7 ± 4.9 days; P = 0.02). Delirium was numerically lower but not statistically significant (22.22% vs 35.42%; P = 0.19), and no significant differences were observed in unplanned extubation, reintubation within 48 hours, tracheostomy, or 28-day mortality. After adjustment, nurse-led targeted management was associated with shorter ventilation duration (adjusted ratio, 0.79; 95% CI, 0.67–0.93; P = 0.004), whereas the association with delirium was not significant (adjusted OR, 0.58; 95% CI, 0.26–1.30; P = 0.190). Conclusion In this retrospective cohort study, nurse-led targeted sedation-analgesia management was associated with higher sedation target attainment, lower exposure to deep sedation and agitation, shorter invasive mechanical ventilation duration, and shorter ICU stay. No increase in measured safety events was detected. Given the retrospective design, small sample size, and limited adjustment, these findings should be interpreted as associations rather than evidence of causal effectiveness.