Protocolized sedation effect on post-ICU posttraumatic stress disorder prevalence: A systematic review and network meta-analysis

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• 作者：Antonio Paulo Nassar Jr. ; MD^a ; ^b ; ¹ ; ^{paulo_nassar@yahoo.com.br" class="auth_mail" title="E-mail the corresponding author} ; Fernando G. Zampieri ; MD^a ; ^c ; ¹ ; Otavio T. Ranzani ; MD^d ; Marcelo Park ; PhD^a
• 关键词：Sedation ; Conscious sedation ; Posttraumatic stress disorder ; Mechanical ventilation ; Meta-analysis
• 刊名：Journal of Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：30
• 期：6
• 页码：1278-1282
• 全文大小：324 K

文摘

Strategies aiming light sedation are associated with decreased length on mechanical ventilation. However, awake or easily arousable patients may be prone to greater prevalence of posttraumatic stress disorder (PTSD). These systematic review and meta-analysis aimed to evaluate the safety of light sedation strategies regarding the prevalence of PTSD.

Methods

We searched MEDLINE, Scopus, and Web of Science from inception to November 2014 for randomized controlled trials that evaluated light sedation strategies and addressed PTSD prevalence in the follow-up as a specific outcome. Because not all trials performed the same comparisons, we performed a network meta-analysis to evaluate indirect comparisons.

Results

Five studies fulfilled our inclusion criteria and were included in the meta-analysis. Two studies compared daily sedation interruption with usual care (92 patients), 2 studies compared a light sedation protocol with daily sedation interruption (47 patients), and 1 study compared light and deep sedation (102 patients). Compared with usual sedation care/deep sedation, neither daily interruption of sedation (odds ratio = 0.66; 95% confidence interval, 0.22-1.98) nor a light sedation protocol (odds ratio = 0.90, 95% confidence interval, 0.27-3.05) was associated with increased risks on long-term PTSD prevalence.

Conclusion

Light sedation strategies seem to be safe in terms of PTSD prevalence. However, the small number of included trials and patients may not be sufficient to drive strong statements.