Volatile Agents in Medical and Surgical Intensive Care Units: A Meta-Analysis of Randomized Clinical Trials

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• 作者：Giovanni Landoni ; MD^* ; ^&dagger ; ; ^{landoni.giovanni@hsr.it" class="auth_mail" title="E-mail the corresponding author} ; Laura Pasin ; MD^* ; Luca Cabrini ; MD^* ; Anna Mara Scandroglio ; MD^* ; Martina Baiardo Redaelli ; MD^* ; Carmine Domenico Votta ; MD^* ; Mattia Bellandi ; MD^* ; Giovanni Borghi ; MD^* ; Alberto Zangrillo^* ; ^&dagger ;
• 关键词：volatile agents ; anesthesia ; intensive care ; sedation ; mechanical ventilation ; critically ill
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：30
• 期：4
• 页码：1005-1014
• 全文大小：706 K

文摘

To comprehensively assess published randomized peer-reviewed studies related to volatile agents used for sedation in intensive care unit (ICU) settings, with the hypothesis that volatile agents could reduce time to extubation in adult patients.

Design

Systematic review and meta-analysis of randomized trials.

Setting

Intensive care units.

Participants

Critically ill patients.

Interventions

None.

Measurements and Main Results

The BioMedCentral, PubMed, Embase, and Cochrane Central Register databases of clinical trials were searched systematically for studies on volatile agents used in the ICU setting. Articles were assessed by trained investigators, and divergences were resolved by consensus. Inclusion criteria included random allocation to treatment (volatile agents versus any intravenous comparator, with no restriction on dose or time of administration) in patients requiring mechanical ventilation in the ICU. Twelve studies with 934 patients were included in the meta-analysis. The use of halogenated agents reduced the time to extubation (standardized mean difference = –0.78 [–1.01 to –0.55] hours; p for effect<0.00001; p for heterogeneity = 0.18; I² = 32% in 7 studies with 503 patients). Results for time to extubation were confirmed in all subanalyses (eg, medical and surgical patients) and sensitivity analyses. No differences in length of hospital stay, ICU stay, and mortality were recorded.

Conclusions

In this meta-analysis of randomized trials, volatile anesthetics reduced time to extubation in medical and surgical ICU patients. The results of this study should be confirmed by large and high-quality randomized controlled studies.