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

Abstract

ObjectiveThe 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.MethodsWe 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.ResultsSeven 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.ConclusionSedation 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.

Mobilização precoce a prática do fisioterapeuta intensivista: intervenções e barreiras

“…Dubb et al 26 identificaram 28 barreiras à MP, sendo classificadas em quatro grupos: barreiras estruturais, culturais, relacionadas ao processo de mobilização e as relacionadas ao paciente. Nosso estudo identificou que as barreiras relacionadas ao paciente foram as mais limitantes, porém é importante destacar que existem outras barreiras menos frequentes nesse estudo, como a escassez de recursos terapêuticos para realizar essa prática.…”

Should We Use DSI or not—What does the PADIS 2018 Guidelines Recommend?

“…Nassar et al 5 in their systematic review and meta-analysis found target sedation protocols and DSI, similar in terms of hospital mortality, duration of mechanical ventilation, hospital length of stay, accidental extubation, extubation failure and the occurrence of delirium. However, 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; 12 = 87.2%) and a shorter duration of hospital length of stay (mean difference = –5.05 days, 95% CI –9.98–0.11 days; 12 = 69%).…”