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Meta-Analysis
. 2016 Oct-Dec;28(4):444-451.
doi: 10.5935/0103-507X.20160078.

Sedation protocols versus daily sedation interruption: a systematic review and meta-analysis

[Article in Portuguese, English]
Antonio Paulo Nassar Junior  1 , Marcelo Park  1
Affiliations
Meta-Analysis

Sedation protocols versus daily sedation interruption: a systematic review and meta-analysis

[Article in Portuguese, English]
Antonio Paulo Nassar Junior et al. Rev Bras Ter Intensiva. 2016 Oct-Dec.

Abstract
in English, Portuguese

Objective:: The aim of this study was to systematically review studies that compared a mild target sedation protocol with daily sedation interruption and to perform a meta-analysis with the data presented in these studies.

Methods:: We searched Medline, Scopus and Web of Science databases to identify randomized clinical trials comparing sedation protocols with daily sedation interruption in critically ill patients requiring mechanical ventilation. The primary outcome was mortality in the intensive care unit.

Results:: Seven studies were included, with a total of 892 patients. Mortality in the intensive care unit did not differ between the sedation protocol and daily sedation interruption groups (odds ratio [OR] = 0.81; 95% confidence interval [CI] 0.60 - 1.10; I2 = 0%). Hospital mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay did not differ between the groups either. Sedation protocols were associated with an increase in the number of days free of mechanical ventilation (mean difference = 6.70 days; 95%CI 1.09 - 12.31 days; I2 = 87.2%) and a shorter duration of hospital length of stay (mean difference = -5.05 days, 95%CI -9.98 - -0.11 days; I2 = 69%). There were no differences in regard to accidental extubation, extubation failure and the occurrence of delirium.

Conclusion:: Sedation protocols and daily sedation interruption do not appear to differ in regard to the majority of analyzed outcomes. The only differences found were small and had a high degree of heterogeneity.

Objetivo: Revisar, de forma sistemática, os estudos que compararam um protocolo com alvo de sedação leve e a interrupção diária da sedação, bem como realizar uma metanálise com os dados apresentados nestes estudos.

Métodos: Foram realizadas buscas nas bases de dados Medline, Scopus e Web of Science para a identificação estudos clínicos randomizados que compararam protocolos de sedação com a interrupção diária da sedação em pacientes críticos com necessidade de ventilação mecânica. O desfecho primário analisado foi mortalidade na unidade de terapia intensiva.

Resultados: Foram incluídos 7 estudos, com total de 892 pacientes. A mortalidade na unidade de terapia intensiva não foi diferente entre os grupos protocolo de sedação ou interrupção diária da sedação (OR = 0,81; IC 95% 0,60 - 1,10; I2 = 0%). Mortalidade hospitalar, duração da ventilação mecânica e da internação na unidade de terapia intensiva também não foram diferentes dentre os grupos. Os protocolos de sedação associaram-se a um aumento do número de dias livres de ventilação mecânica (diferença média = 6,70 dias; IC95% 1,09 - 12,31 dias; I2 = 87,2%). Os protocolos de sedação associaram-se a uma menor duração da internação hospitalar (diferença média = -5,05 dias; IC 95% -9,98 - -0,11 dias; I2 = 69%). Não houve diferenças quanto à extubação acidental, à falha de extubação e à ocorrência de delirium.

Conclusão: Protocolos de sedação e interrupção diária da sedação não parecem diferentes quanto à maioria dos desfechos analisados. As diferenças encontradas foram pequenas e com um elevado grau de heterogeneidade.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Mortality in the intensive care unit. OR - odds ratio; 95%CI: 95% confidence interval; W - weight of study.
Figure 3
Figure 3
Time on mechanical ventilation. SD - standard deviation; MD - mean difference; 95%CI - 95% confidence interval; W - weight of study.
See this image and copyright information in PMC

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