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Sedation in the intensive care unit: a systematic review
M E Ostermann1, S P Keenan, R A Seiferling
1Department of Medicine, University of Western Ontario, Canada.
JAMA
|March 25, 2000
Summary
Propofol offers effective sedation and faster extubation than midazolam but carries risks. More research is needed to compare sedative agents for critically ill patients, optimizing mechanical ventilation and ICU stays.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Evidence-Based Practice
Background:
- Sedation is crucial in critical care for patient comfort.
- However, sedatives can cause adverse effects and prolong mechanical ventilation, increasing healthcare costs.
Purpose of the Study:
- To compare different sedation methods for optimal patient outcomes.
- To identify sedation strategies that minimize mechanical ventilation duration and intensive care unit (ICU) length of stay.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) published between 1980 and June 1998.
- Searched MEDLINE, EMBASE, Cochrane databases, and anesthesiology journals.
- Included RCTs comparing at least two sedative agents in adult patients requiring mechanical ventilation.
Main Results:
- 32 RCTs met criteria, comparing various agents including propofol and midazolam.
- Propofol showed comparable sedation efficacy to midazolam, with faster extubation times but increased hypotension risk and cost.
- Limited data exist on ICU length of stay; isoflurane and ketamine showed potential advantages in specific contexts.
Conclusions:
- Propofol is a viable alternative to midazolam for short-term sedation, balancing efficacy with potential side effects.
- Further high-quality RCTs are essential to establish optimal sedative agents for both short-term and long-term critical care sedation.
- Evidence is insufficient to guide sedative selection based on ICU length of stay.
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