Different Depths of Sedation Versus Risk of Delirium in Adult Mechanically Ventilated Patients: A Systematic Review and Meta-analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2020 Jul 17

PMID 32673352

Citations 8

Authors

Ling Long

Shan Ren

Yichun Gong

Haotian Zhao

Cong He

Limin Shen

Heling Zhao

Penglin Ma

Affiliations

Soon will be listed here.

Abstract

Background: Delirium is multifactorial. This study aimed at determining the association between different depths of sedation and the risk of delirium in adult mechanically ventilated patients.

Methods: A systematic literature retrieval was conducted in databases including Cochrane Central Register of Controlled Trials, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature for publications available till December 2019 without limitation in study type, and followed by a secondary retrieval for related literature. STATA15.1 and WinBugs 14.3 were used in statistical analyses for different sedation depths as the intervention. The main endpoint was delirium occurrence. Secondary endpoints were agitation-related adverse events and mortality.

Results: We included 18 studies comprising 8001 mechanically ventilated patients. Different sedation depths were not associated with the occurrence of delirium (OR = 1.00, 95%CI: 0.64-1.58, P = 0.993). Among the 18 enrolled studies, this finding was not confounded by the dosage of benzodiazepines (OR = 0.96, 95%CI: 0.79-1.17, P = 0.717) in eight randomized controlled trials(RCTs) or the patients' disease severity(OR 0.95, 95%CI: 0.79-1.13, P = 0.548) in 10 RCTs. However, contrasting results were found in non-RCTs. The deeper sedation group had a significantly increased risk for death(OR = 1.82, 95% CI: 1.23-2.69, P = 0.003), whereas lighter sedation seemed a potential risk for agitation-related adverse events (OR = 0.61, 95%CI: 0.45-0.84, P = 0.002).

Conclusions: It is inconclusive whether significantly different sedation depths would change the risk of delirium in adult mechanically ventilated patients.

Trial Registration Number: The study was registered in PROSPERO(http://www.crd.york.ac.uk/PROSPERO/) under registration number CRD42019145276.

Citing Articles

Effect of level of sedation on outcomes in critically ill adult patients: a systematic review of clinical trials with meta-analysis and trial sequential analysis.

Ceric A, Holgersson J, May T, Skrifvars M, Hastbacka J, Saxena M EClinicalMedicine. 2024; 71:102569.

PMID: 38572080 PMC: 10990717. DOI: 10.1016/j.eclinm.2024.102569.

Reckoning the Inhaled Sedation in Critically Ill Patients (INSTINCT) Study.

Karim H, Mitra J Indian J Crit Care Med. 2023; 26(11):1227-1228.

PMID: 36873584 PMC: 9983656. DOI: 10.5005/jp-journals-10071-24356.

Level of sedation in critically ill adult patients: a protocol for a systematic review with meta-analysis and trial sequential analysis.

Ceric A, Holgersson J, May T, Skrifvars M, Hastbacka J, Saxena M BMJ Open. 2023; 12(9):e061806.

PMID: 36691212 PMC: 9462111. DOI: 10.1136/bmjopen-2022-061806.

Factors Associated With Deep Sedation Practice in Mechanically Ventilated Patients: A Analysis of a Cross-Sectional Survey Combined With a Questionnaire for Physicians on Sedation Practices.

Ma P, Wang T, Gong Y, Liu J, Shi W, Zeng L Front Med (Lausanne). 2022; 9:839637.

PMID: 35755030 PMC: 9218424. DOI: 10.3389/fmed.2022.839637.

Non-Pharmacological Interventions for Minimizing Physical Restraints Use in Intensive Care Units: An Umbrella Review.

Cui N, Yan X, Zhang Y, Chen D, Zhang H, Zheng Q Front Med (Lausanne). 2022; 9:806945.

PMID: 35573001 PMC: 9091438. DOI: 10.3389/fmed.2022.806945.

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