{
  "abstract": "Observational studies comparing sedation depth strategies in mechanically ventilated patients have relied on observed consciousness levels alone to define exposure, potentially conflating intentional drug-induced sedation with low arousal caused by residual medications, other agents, or underlying illness. We applied the target trial emulation framework with the clone-censor-weight method to compare early deep-to-light sedation (DTLS) versus a sustained light-or-awake strategy, using a joint exposure definition that requires both Richmond Agitation-Sedation Scale (RASS) depth and qualifying continuous sedative infusion. Using MIMIC-IV (2008–2022), we identified 5,086 adults receiving invasive mechanical ventilation for ≥ 48 h. Each patient was cloned to both strategies. During the primary 144-hour adherence window, inverse probability weights accounted for measured predictors of artificial censoring. The primary outcome was 28-day ventilator-free days (VFDs); successful extubation was analysed with death as a competing event. VFD outcomes were observed before artificial censoring in 1,481 sustained-light-or-awake and 622 DTLS clones. Weighted mean VFDs were 17.72 days for DTLS versus 17.76 days for sustained light-or-awake, a difference of − 0.04 days (95% CI, − 1.32–1.29). The cause-specific extubation HR was 0.97 (95% CI, 0.84–1.11). A sensitivity cohort without future minimum ventilation or ICU-duration requirements ( n = 15,842) showed fewer VFDs with DTLS (difference, − 1.03 days; 95% CI, − 1.47 to − 0.61). These findings do not establish a DTLS benefit; duration-based selection, residual confounding, and limited late-window support constrain interpretation.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "name": "Yuhang Zhang"
    },
    {
      "name": "Menglin Han"
    },
    {
      "name": "Xiaosu Liu"
    },
    {
      "name": "Guanyu Chen"
    },
    {
      "name": "Lulu Zhang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7azp79n32nqcy.bib",
  "cited_by": 0,
  "doi": "10.1038/s41598-026-75074-2",
  "fulltext_url": null,
  "id": "7azp79n32nqcy",
  "issns": [
    "2045-2322"
  ],
  "landing_url": "https://www.nature.com/articles/s41598-026-75074-2",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2706|Intensive Care Unit Cognitive Disorders"
    ]
  ],
  "openalex": "W7222036860",
  "pdf_url": "https://www.nature.com/articles/s41598-026-75074-2_reference.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-15",
  "publisher": "Springer Science and Business Media LLC",
  "ris": "https://research.draconitic.com/paper/7azp79n32nqcy.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:28Z",
      "native_id": "10.1038/s41598-026-75074-2",
      "source": "crossref",
      "url": "https://www.nature.com/articles/s41598-026-75074-2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2706|Intensive Care Unit Cognitive Disorders",
      "subfield": "general"
    }
  ],
  "title": "Early deep-to-light sedation versus a sustained light-or-awake strategy in mechanically ventilated adults: a target trial emulation",
  "title_text": "Early deep-to-light sedation versus a sustained light-or-awake strategy in mechanically ventilated adults: a target trial emulation",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:28Z",
  "url": "https://research.draconitic.com/paper/7azp79n32nqcy",
  "venue": "Scientific Reports",
  "versions": []
}