Latino Respirator Patients More Likely to Be Oversedated: Study

New research suggests that Latino hospital patients requiring mechanical ventilation due to respiratory distress are more likely to be oversedated by doctors, raising concerns about implicit bias among doctors and the impact of language barriers in the hospital.

In a study published last month in the Annals of the American Thoracic Society, researchers indicate that Latino patients suffering from acute respiratory distress syndrome (ARDS) are five times more likely to be given deep sedation compared to white patients, no matter what their medical condition.

ARDS is a life-threatening condition that causes fluid to leak into the lungs, making breathing difficult. The most common reasons for developing ARDS include sepsis and infection from viruses like COVID-19 and the flu. However, it can also be caused by chronic lung disease and smoke inhalation.

Patients with ARDS suffer from shortness of breath, rapid heart rate, coughing with phlegm, fatigue, and fever.

In this latest study, researchers from New York University and the University of Michigan researched ethnicity and oversedation among patients with ARDS. They reviewed data on patients enrolled in a randomized clinical trial for a neuromuscular block for ARDS in 48 U.S. hospitals.

According to the findings, hospitals with at least one Latino patient kept all Latino patients oversedated longer than hospitals caring for no Latino patients.

The data indicates Latino patients were oversedated on 86% of the days they were put on a ventilator, compared to white patients who were oversedated on 66% of days they were put on a ventilator.

Oversedation Can Cause Respiratory Distress

Researchers warn that oversedating patients can increase the risk of potentially severe symptoms from ARDS, further increasing the risks for hospitalized Latino patients.

Deep sedation is when anesthesia is given to a patient to cause sleep. However, if doctors give too much of anesthesia or other sedation medications, it may cause patients to lose feeling or be hard to wake up.

The researchers determined that patients overall were more likely to be oversedated if they were put on a ventilator. Prior research has found that oversedation of patients on ventilators can increase the risk of them experiencing a variety of adverse side effects, including choking, heart failure, brain damage or death.

Implicit Bias May Play Role in Oversedation

Latinos are the largest minority group in the United States, and prior research has established that Latinos are more likely to die from ARDS than white patients.

According to this new study, Latinos may face a higher risk of being oversedated due to language differences with doctors. Patients who are put on ventilators must be assessed to ensure they can communicate with medical staff to indicate how they are feeling. However, a communication barrier may make determining the patient’s level of sedation more difficult.

But the data from the study indicated no matter the hospital or location, Latino patients were more likely to be oversedated than any other patient group, regardless of their medical condition, suggesting the language barrier may not be the only factor at play.

Researchers suggest that implicit bias in doctors’ decision-making might also play a role in causing doctors to incorrectly assess a Latino patient’s level of delirium or agitation, leading them to oversedate those patients. Additionally, some intensive care units rely on deeper levels of sedation as a standard policy.

Because Latino patients face a higher risk of being oversedated than white patients, researchers determined there is an urgent need to address sedation levels and differences in medical care among patients of different ethnicities.