Chemical agents for the sedation of agitated patients in the ED: a systematic review

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• 作者：Viola Korczak ; MD ; MIPH^a ; Adrienne Kirby ; MS^b ; Naren Gunja ; MD ; MS^c ; ^d ; ^{naren.gunja@sydney.edu.au}
• 刊名：The American Journal of Emergency Medicine
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：34
• 期：12
• 页码：2426-2431
• 全文大小：1021 K
• 卷排序：34

文摘

Chemical agents commonly used to sedate agitated patients in the emergency department include benzodiazepines, antipsychotics, or a combination of the 2 classes. Our objective was to determine if a class or combination therapy is (1) more effective, as measured by the proportion sedated at 15-20 minutes and the need for repeat sedation, and (2) safer, as measured by the proportion of reported adverse events.MethodsSystematic literature review and meta-analysis of studies comparing 2 or more chemical agents for sedation of agitated patients in the emergency department were carried out in PubMed, PsycINFO, Embase, and the Cochrane database. Meta-analyses for pairwise comparisons of drug class (benzodiazepine, antipsychotic, or combination) were carried out for each outcome: proportion sedated, need for repeat sedation, and adverse events.ResultsSeven studies with 1135 patients were included. At 15-20 minutes, the proportion of patients sedated was greater with combination therapy than benzodiazepines alone (risk ratio [RR] = 1.31, P < .0001). Antipsychotics and combination agents required significantly less repeat sedations than benzodiazepines alone (RR = 0.49, P < .0001 and RR = 0.64, P = .002). There was significant heterogeneity in adverse event data, with respiratory system adverse events (desaturation, and need for airway and ventilatory support) being the most commonly reported. Benzodiazepines were associated with a higher incidence of adverse events than antipsychotics or combination therapy.ConclusionCombination therapy sedated a greater proportion of patients at 15-20 minutes than benzodiazepines alone. Antipsychotics and combination therapy were more effective, requiring less repeat doses for sedation than benzodiazepines. The risk of any adverse event was higher with benzodiazepines.