Impact of sedation levels on outcomes in neurocritical care patients with intracranial hemorrhage: a retrospective cohort study

Sedation in neurointensive care is essential for managing patients with acute brain injuries. While sedation is commonly employed to alleviate stress responses and enhance patient comfort, the relationship between sedation practices and clinical outcomes remains unclear. This retrospective cohort study analyzed electronic medical records of patients with intracranial hemorrhage admitted to a tertiary care neurosurgical center from January 2020 to December 2023. Patients with a Glasgow Coma Scale (GCS) ≥ 13, early mortality, or prior treatment elsewhere were excluded. Sedation depth was assessed using the Richmond Agitation-Sedation Scale. Outcomes included intensive care unit (ICU) length of stay, Glasgow coma scale at discharge, modified Rankin Scale (mRS) at three months, and infection rates. Among 562 patients screened, 138 met inclusion criteria, with 73 (52.9%) receiving sedation. No significant differences were observed in ICU stay, discharge GCS, or mRS between sedation and non-sedation groups, nor between light and deep sedation. The sedation group had longer mechanical ventilation (15 ± 12 days vs. 7.03 ± 12.83 days; p < 0.05) but similar rates of hospital acquired pneumonia (68.49% vs. 50.77%; p = 0.44). Sedation depth and the decision to sedate did not significantly impact key clinical outcomes. Individualized sedation strategies should prioritize patient comfort and clinical needs without assuming deeper sedation adversely affects recovery.