Journal of critical care · 2026
Sedation trajectories and circadian rhythm disruption in critically ill adults: an observational cohort study with external validation using MIMIC-IV and eICU-CRD.
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Zhang Yuhang, Wang Xujiao, Wang Qiong, Chen Guanyu, Zhang Lulu
Аннотация
BACKGROUND: Whether ICU sedation strategies are associated with circadian rhythmicity of vital signs, and whether such disruption mediates delirium, remains unclear.
METHODS: In a retrospective cohort study of MIMIC-IV (n = 13,592 surgical and mixed medical-surgical ICU patients), with supportive external validation in eICU-CRD (n = 12,004), multivariate dynamic time warping (DTW)-based clustering classified four sedation trajectories over 48 h. Rhythmicity parameters of four vital signs were quantified from available ICU-stay recordings using Lomb-Scargle, wavelet, entropy, and cosinor methods. Marginal structural models estimated associations, and exploratory mediation analysis examined indirect pathways.
RESULTS: Sustained high-dose propofol showed the weakest vital-sign rhythmicity. Compared with this group, the early high-dose propofol and propofol-to-dexmedetomidine transition groups had higher spectral power for heart rate (β = 0.033 and 0.015) and temperature (β = 0.055 and 0.020; all P < 0.001). With CAM-ICU as the primary delirium measure, temperature wavelet power formed an exploratory indirect pathway (proportion mediated 23.5%, 95% CI 16.9-31.0%; Group 2 vs. 3), though this ranged from 0% to 34% across assumptions. In eICU-CRD, temperature-derived parameters were directionally consistent (Cohen's d 0.263 to 0.426).
CONCLUSIONS: ICU sedation trajectories were associated with vital-sign rhythmicity parameters. Temperature-derived rhythmicity was consistent with an exploratory indirect pathway to delirium, but estimates depended on analytic assumptions. These proxies should not be interpreted as direct measures of central circadian function.
METHODS: In a retrospective cohort study of MIMIC-IV (n = 13,592 surgical and mixed medical-surgical ICU patients), with supportive external validation in eICU-CRD (n = 12,004), multivariate dynamic time warping (DTW)-based clustering classified four sedation trajectories over 48 h. Rhythmicity parameters of four vital signs were quantified from available ICU-stay recordings using Lomb-Scargle, wavelet, entropy, and cosinor methods. Marginal structural models estimated associations, and exploratory mediation analysis examined indirect pathways.
RESULTS: Sustained high-dose propofol showed the weakest vital-sign rhythmicity. Compared with this group, the early high-dose propofol and propofol-to-dexmedetomidine transition groups had higher spectral power for heart rate (β = 0.033 and 0.015) and temperature (β = 0.055 and 0.020; all P < 0.001). With CAM-ICU as the primary delirium measure, temperature wavelet power formed an exploratory indirect pathway (proportion mediated 23.5%, 95% CI 16.9-31.0%; Group 2 vs. 3), though this ranged from 0% to 34% across assumptions. In eICU-CRD, temperature-derived parameters were directionally consistent (Cohen's d 0.263 to 0.426).
CONCLUSIONS: ICU sedation trajectories were associated with vital-sign rhythmicity parameters. Temperature-derived rhythmicity was consistent with an exploratory indirect pathway to delirium, but estimates depended on analytic assumptions. These proxies should not be interpreted as direct measures of central circadian function.