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Protocolized sedation effect on post-ICU posttraumatic stress disorder prevalence: A systematic review and network
Antonio Paulo Nassar1, Fernando G Zampieri2, Otavio T Ranzani3
1Discipline of Medical Emergencies, Hospital das Clinicas, University of São Paulo; Adult Intensive Care Unit, A.C. Camargo Canter Center.
Purpose:
Strategies aiming light sedation are associated with decreased length on mechanical ventilation. However, awake or easily arousable patients may be prone to greater prevalence of posttraumatic stress disorder (PTSD). These systematic review and meta-analysis aimed to evaluate the safety of light sedation strategies regarding the prevalence of PTSD.
Methods:
We searched MEDLINE, Scopus, and Web of Science from inception to November 2014 for randomized controlled trials that evaluated light sedation strategies and addressed PTSD prevalence in the follow-up as a specific outcome. Because not all trials performed the same comparisons, we performed a network meta-analysis to evaluate indirect comparisons.
Results:
Five studies fulfilled our inclusion criteria and were included in the meta-analysis. Two studies compared daily sedation interruption with usual care (92 patients), 2 studies compared a light sedation protocol with daily sedation interruption (47 patients), and 1 study compared light and deep sedation (102 patients). Compared with usual sedation care/deep sedation, neither daily interruption of sedation (odds ratio=0.66; 95% confidence interval, 0.22-1.98) nor a light sedation protocol (odds ratio=0.90, 95% confidence interval, 0.27-3.05) was associated with increased risks on long-term PTSD prevalence.
Conclusion:
Light sedation strategies seem to be safe in terms of PTSD prevalence. However, the small number of included trials and patients may not be sufficient to drive strong statements.
