Robert J Stephens1, Matthew R Dettmer2, Brian W Roberts3, Enyo Ablordeppey4,5, Susan A Fowler6, Marin H Kollef7, Brian M Fuller4,5. 1. Washington University School of Medicine in St. Louis, St. Louis, MO. 2. Emergency Services Institute, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH. 3. Department of Emergency Medicine, Cooper University Hospital, Camden, NJ. 4. Department of Emergency Medicine, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO. 5. Department of Anesthesiology, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO. 6. Bernard Becker Medical Library, Washington University in St. Louis, St. Louis, MO. 7. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO.
Abstract
OBJECTIVES: Emerging data suggest that early deep sedation may negatively impact clinical outcomes. This systematic review and meta-analysis defines and quantifies the impact of deep sedation within 48 hours of initiation of mechanical ventilation, as described in the world's literature. The primary outcome was mortality. Secondary outcomes included hospital and ICU lengths of stay, mechanical ventilation duration, and delirium and tracheostomy frequency. DATA SOURCES: The following data sources were searched: MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews and Effects, Cochrane Database of Systematic Reviews databases, ClinicalTrials.gov, conference proceedings, and reference lists. STUDY SELECTION: Randomized controlled trials and nonrandomized studies were included. DATA EXTRACTION: Two reviewers independently screened abstracts of identified studies for eligibility. DATA SYNTHESIS: Nine studies (n = 4,521 patients) published between 2012 and 2017 were included. A random effects meta-analytic model revealed that early light sedation was associated with lower mortality (9.2%) versus deep sedation (27.6%) (odds ratio, 0.34 [0.21-0.54]). Light sedation was associated with fewer mechanical ventilation (mean difference, -2.1; 95% CI, -3.6 to -0.5) and ICU days (mean difference, -3.0 (95% CI, -5.4 to -0.6). Delirium frequency was 28.7% in the light sedation group and 48.5% in the deep sedation group, odds ratio, 0.50 (0.22-1.16). CONCLUSIONS: Deep sedation in mechanically ventilated patients, as evaluated in a small number of qualifying heterogeneous randomized controlled trials and observational studies, was associated with increased mortality and lengths of stay. Interventions targeting early sedation depth assessment, starting in the emergency department and subsequent ICU admission, deserve further investigation and could improve outcome.
OBJECTIVES: Emerging data suggest that early deep sedation may negatively impact clinical outcomes. This systematic review and meta-analysis defines and quantifies the impact of deep sedation within 48 hours of initiation of mechanical ventilation, as described in the world's literature. The primary outcome was mortality. Secondary outcomes included hospital and ICU lengths of stay, mechanical ventilation duration, and delirium and tracheostomy frequency. DATA SOURCES: The following data sources were searched: MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews and Effects, Cochrane Database of Systematic Reviews databases, ClinicalTrials.gov, conference proceedings, and reference lists. STUDY SELECTION: Randomized controlled trials and nonrandomized studies were included. DATA EXTRACTION: Two reviewers independently screened abstracts of identified studies for eligibility. DATA SYNTHESIS: Nine studies (n = 4,521 patients) published between 2012 and 2017 were included. A random effects meta-analytic model revealed that early light sedation was associated with lower mortality (9.2%) versus deep sedation (27.6%) (odds ratio, 0.34 [0.21-0.54]). Light sedation was associated with fewer mechanical ventilation (mean difference, -2.1; 95% CI, -3.6 to -0.5) and ICU days (mean difference, -3.0 (95% CI, -5.4 to -0.6). Delirium frequency was 28.7% in the light sedation group and 48.5% in the deep sedation group, odds ratio, 0.50 (0.22-1.16). CONCLUSIONS: Deep sedation in mechanically ventilated patients, as evaluated in a small number of qualifying heterogeneous randomized controlled trials and observational studies, was associated with increased mortality and lengths of stay. Interventions targeting early sedation depth assessment, starting in the emergency department and subsequent ICU admission, deserve further investigation and could improve outcome.
Authors: D F Stroup; J A Berlin; S C Morton; I Olkin; G D Williamson; D Rennie; D Moher; B J Becker; T A Sipe; S B Thacker Journal: JAMA Date: 2000-04-19 Impact factor: 56.272
Authors: Tim C Jansen; Jasper van Bommel; F Jeanette Schoonderbeek; Steven J Sleeswijk Visser; Johan M van der Klooster; Alex P Lima; Sten P Willemsen; Jan Bakker Journal: Am J Respir Crit Care Med Date: 2010-05-12 Impact factor: 21.405
Authors: Brian M Fuller; Ian T Ferguson; Nicholas M Mohr; Anne M Drewry; Christopher Palmer; Brian T Wessman; Enyo Ablordeppey; Jacob Keeperman; Robert J Stephens; Cristopher C Briscoe; Angelina A Kolomiets; Richard S Hotchkiss; Marin H Kollef Journal: Ann Emerg Med Date: 2017-03-02 Impact factor: 5.721
Authors: Richard R Riker; Yahya Shehabi; Paula M Bokesch; Daniel Ceraso; Wayne Wisemandle; Firas Koura; Patrick Whitten; Benjamin D Margolis; Daniel W Byrne; E Wesley Ely; Marcelo G Rocha Journal: JAMA Date: 2009-02-02 Impact factor: 56.272
Authors: Juliana Barr; Gilles L Fraser; Kathleen Puntillo; E Wesley Ely; Céline Gélinas; Joseph F Dasta; Judy E Davidson; John W Devlin; John P Kress; Aaron M Joffe; Douglas B Coursin; Daniel L Herr; Avery Tung; Bryce R H Robinson; Dorrie K Fontaine; Michael A Ramsay; Richard R Riker; Curtis N Sessler; Brenda Pun; Yoanna Skrobik; Roman Jaeschke Journal: Crit Care Med Date: 2013-01 Impact factor: 7.598
Authors: Yahya Shehabi; Rinaldo Bellomo; Michael C Reade; Michael Bailey; Frances Bass; Belinda Howe; Colin McArthur; Ian M Seppelt; Steve Webb; Leonie Weisbrodt Journal: Am J Respir Crit Care Med Date: 2012-08-02 Impact factor: 21.405
Authors: Larissa Shamseer; David Moher; Mike Clarke; Davina Ghersi; Alessandro Liberati; Mark Petticrew; Paul Shekelle; Lesley A Stewart Journal: BMJ Date: 2015-01-02
Authors: David Moher; Larissa Shamseer; Mike Clarke; Davina Ghersi; Alessandro Liberati; Mark Petticrew; Paul Shekelle; Lesley A Stewart Journal: Syst Rev Date: 2015-01-01
Authors: Yahya Shehabi; Lucy Chan; Suhaini Kadiman; Anita Alias; Wan Nasrudin Ismail; Mohd Ali T Ismail Tan; Tien Meng Khoo; Saedah Binti Ali; Mat Ariffin Saman; Ahmad Shaltut; Cheng Cheng Tan; Cow Yen Yong; Michael Bailey Journal: Intensive Care Med Date: 2013-01-24 Impact factor: 17.440
Authors: Christopher G Hughes; Christina S Boncyk; Deborah J Culley; Lee A Fleisher; Jacqueline M Leung; David L McDonagh; Tong J Gan; Matthew D McEvoy; Timothy E Miller Journal: Anesth Analg Date: 2020-06 Impact factor: 5.108
Authors: Brendan P George; J Priyanka Vakkalanka; Karisa K Harland; Brett Faine; Stacey Rewitzer; Anne Zepeski; Brian M Fuller; Nicholas M Mohr; Azeemuddin Ahmed Journal: Prehosp Emerg Care Date: 2020-01-23 Impact factor: 3.077
Authors: Brian M Fuller; Brian W Roberts; Nicholas M Mohr; William A Knight; Opeolu Adeoye; Ryan D Pappal; Stacy Marshall; Robert Alunday; Matthew Dettmer; Munish Goyal; Colin Gibson; Brian J Levine; Jayna M Gardner-Gray; Jarrod Mosier; James Dargin; Fraser Mackay; Nicholas J Johnson; Sharukh Lokhandwala; Catherine L Hough; Joseph E Tonna; Rachel Tsolinas; Frederick Lin; Zaffer A Qasim; Carrie E Harvey; Benjamin Bassin; Robert J Stephens; Yan Yan; Christopher R Carpenter; Marin H Kollef; Michael S Avidan Journal: Crit Care Med Date: 2019-11 Impact factor: 7.598
Authors: Christina S Boncyk; Kimberly F Rengel; Pratik P Pandharipande; Christopher G Hughes Journal: Curr Opin Crit Care Date: 2019-06 Impact factor: 3.687
Authors: Melissa L Rethlefsen; Shona Kirtley; Siw Waffenschmidt; Ana Patricia Ayala; David Moher; Matthew J Page; Jonathan B Koffel Journal: J Med Libr Assoc Date: 2021-04-01