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

Aitken, Leanne M.; Kydonaki, Kalliopi; Blackwood, Bronagh; Trahair, Laurence G.; Purssell, Edward; Sekhon, Mandeep; Walsh, Timothy Simon

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, CENTRAL, CINAHL, PsycINFO from 2000 - 2020.
Randomised controlled trials 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: -1.54 days [95% CI -2.68 to -0.39]). 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.

• Journal Article Type: Review
• Acceptance Date: Mar 19, 2021
• Online Publication Date: Apr 15, 2021
• Publication Date: 2021-10
• Deposit Date: Mar 26, 2021
• Publicly Available Date: Apr 15, 2021
• Print ISSN: 0040-6376
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 76
• Issue: 11
• Pages: 1089-1098
• DOI: https://doi.org/10.1136/thoraxjnl-2020-216098
• Keywords: critical care, sedation, deep sedation, systematic review, patient outcome assessment, critical care outcomes
• Public URL: http://researchrepository.napier.ac.uk/Output/2755853