Effect of Protocolized Sedation on Clinical Outcomes in Mechanically Ventilated Intensive Care Unit Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective: To assess the effects of protocolized sedation (algorithm or daily interruption) compared with usual care without protocolized sedation on clinical outcomes in mechanically ventilated adult intensive care unit (ICU) patients via a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov from their inception to February 28, 2013. A random-effects model was used to synthesize risk ratios (RRs) and weighted mean differences (WMDs). Results: Of 4782 records screened, 6 RCTs including 1243 patients met the inclusion criteria. Protocolized sedation was associated with significant reductions in overall mortality (RR, 0.85; 95% CI, 0.74 to 0.97; P = .02; number needed to treat, 20; P = .11), ICU length of stay (WMD, -1.73 days; 95% CI, -3.32 to -0.14 days; P = .03), hospital length of stay (WMD, -3.55 days; 95% CI, -5.98 to -1.12 days; P = .004), and tracheostomy (RR, 0.69; 95% CI, 0.50 to 0.96; P = .03; number needed to treat, 16.6; P = .04; 5 RCTs) compared with usual care. Protocolized sedation produced no significant differences in duration of mechanical ventilation (WMD, -1.04 days; 95% CI, -2.54 to 0.47 days; P = .18), reintubation (RR, 0.78; 95% CI, 0.52 to 1.15; P = .21; 3 RCTs), and self-extubation (RR, 1.49; 95% CI, 0.46 to 4.82; P = .51; 4 RCTs) compared with usual care. Included studies did not report delirium incidence. Conclusion: In mechanically ventilated adults in closed, nonspecialty ICUs, protocolized sedation seems to decrease overall mortality (15%), ICU and hospital lengths of stay (1.73 and 3.55 days, respectively), and tracheostomy (31%) compared with usual care without protocolized sedation. (C) 2015 Mayo Foundation for Medical Education and Research