The impact of analgosedation on mortality and delirium in critically ill patients: A systematic review and meta-analysis

Abstract

Objectives: To assess the impact of analgosedation on mortality and delirium in critically ill patients.

Research methodology: A systematic review and meta-analysis was conducted to identify studies through Pubmed, Cochrane Library, Embase and Web of Science published from June 2017 to July 2018. Only articles published in English were considered. The Cochrane Collaboration Risk of Bias Tool was used to evaluate the methodological quality of randomised trials, while Newcastle-Ottawa Scale (NOS) was used for cohort studies.

Results: Seventeen eligible studies were identified, including 2298 patients (1170 in the experimental group and 1128 in the control group). Varying analgesics and sedatives were investigated, showing a high clinical heterogeneity. Analgosedation significantly decreased the ICU mortality rate when compared to conventional analgesia and sedation [odds ratio (OR) 0.72, 95%CI 0.53-0.97; P = 0.03]. No significant difference was demonstrated in 28-day/hospital mortality rate [OR 0.91, 95%CI 0.70-1.18; P = 0.48] or in the incidence of delirium [OR 1.06, 95%CI 0.78-1.45; P = 0.70]. However, subgroup analysis of trials indicated a significant increase in the delirium rate (OR: 1.88, 95%CI 1.14-3.10, p = 0.01).

Conclusion: The ICU mortality was decreased by implementing analgosedation, but the hospital mortality and the delirium rates were not. Because of the absence of higher quality study designs, clinical heterogeneity and inclusion of small number of studies, the analysis results must be cautiously interpreted.

Keywords: Analgesia-based sedation; Analgesia-first sedation; Analogsedation; Critically ill patients; Delirium; Meta-analysis; Mortality; No sedation; Systematic review.