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Sedation protocols versus daily sedation interruption: a systematic review and meta-analysis
Antonio Paulo Nassar1, Marcelo Park1
1Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.
Revista Brasileira De Terapia Intensiva
|January 19, 2017
Summary
Mild target sedation protocols and daily sedation interruption show similar outcomes for critically ill patients. No significant differences were found in mortality or ventilation duration, though protocols may increase days free from mechanical ventilation.
Area of Science:
- Critical Care Medicine
- Respiratory Therapy
- Evidence-Based Medicine
Background:
- Sedation management is crucial for mechanically ventilated patients in intensive care units (ICUs).
- Daily sedation interruption (DSI) is a common strategy, but its comparison with targeted sedation protocols requires systematic evaluation.
Purpose of the Study:
- To systematically review and meta-analyze randomized clinical trials comparing mild target sedation protocols with DSI.
- To assess the impact of these sedation strategies on patient outcomes, including mortality and ventilation duration.
Main Methods:
- Searched Medline, Scopus, and Web of Science for relevant randomized clinical trials.
- Included 7 studies with 892 critically ill patients requiring mechanical ventilation.
- Primary outcome was intensive care unit mortality; secondary outcomes included hospital mortality, ventilation duration, and length of stay.
Main Results:
- No significant difference in intensive care unit or hospital mortality between sedation protocols and DSI (OR = 0.81; 95% CI 0.60 - 1.10).
- Sedation protocols showed a trend towards more days free from mechanical ventilation (MD = 6.70 days) and shorter hospital stays (MD = -5.05 days), with significant heterogeneity.
- No differences observed in accidental extubation, extubation failure, or delirium incidence.
Conclusions:
- Mild target sedation protocols and DSI demonstrate comparable outcomes for most analyzed parameters in critically ill patients.
- Observed differences in days free from ventilation and hospital stay were modest and associated with considerable heterogeneity.
- Further research may be needed to clarify optimal sedation strategies, considering potential benefits and heterogeneity.
