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Inconsistent relationship between depth of sedation and intensive care outcome: systematic review and meta-analysis

Aitken, L. M. ORCID: 0000-0001-5722-9090, Kydonaki, K., Blackwood, B., Trahair, L. G., Purssell, E. ORCID: 0000-0003-3748-0864, Sekhon, M. and Walsh, T. S. (2021). Inconsistent relationship between depth of sedation and intensive care outcome: systematic review and meta-analysis. Thorax, doi: 10.1136/thoraxjnl-2020-216098

Abstract

PURPOSE: To determine the effect of depth of sedation on intensive care mortality, duration of mechanical ventilation, and other clinically important outcomes.

METHODS: We searched MEDLINE, Embase, Cochrane Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PsycINFO from 2000 to 2020. Randomised controlled trials (RCTs) and cohort studies that examined the effect of sedation depth were included. Two reviewers independently screened, selected articles, extracted data and appraised quality. Data on study design, population, setting, patient characteristics, study interventions, depth of sedation and relevant outcomes were extracted. Quality was assessed using Critical Appraisal Skills Programme tools.

RESULTS: We included data from 26 studies (n=7865 patients): 8 RCTs and 18 cohort studies. Heterogeneity of studies was substantial. There was no significant effect of lighter sedation on intensive care mortality. Lighter sedation did not affect duration of mechanical ventilation in RCTs (mean difference (MD): -1.44 days (95% CI -3.79 to 0.91)) but did in cohort studies (MD: -1.52 days (95% CI -2.71 to -0.34)). No statistically significant benefit of lighter sedation was identified in RCTs. In cohort studies, lighter sedation improved time to extubation, intensive care and hospital length of stay and ventilator-associated pneumonia. We found no significant effects for hospital mortality, delirium or adverse events.

CONCLUSION: Evidence of benefit from lighter sedation is limited, with inconsistency between observational and randomised studies. Positive effects were mainly limited to low quality evidence from observational studies, which could be attributable to bias and confounding factors.

Publication Type: Article
Additional Information: This article has been accepted for publication in Thorax, 2021 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/thoraxjnl-2020-216098. © Authors (or their employer(s)) 2021. Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non commercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RT Nursing
Departments: School of Health Sciences
School of Health Sciences > Nursing
Date Deposited: 14 May 2021 13:13
URI: https://openaccess.city.ac.uk/id/eprint/26143
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