| Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysis |
Ambrus Szemere1, Alíz Fazekas2, Anna Réka Sebestyén1,3, Rani Ezzeddine1, Veronika Upor1, Marie Anne Engh1, Péter Hegyi1,2,4, Zsolt Molnár1,5,6, Klára Horváth7 
|
1Centre for Translational Medicine, Semmelweis University , Budapest, Hungary
2Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
3Heim Pal National Pediatric Institute, Budapest, Hungary
4Institute for Pancreatic Diseases, Semmelweis University, Budapest, Hungary
5Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
6Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Poznan, University of Medical Sciences, Poznan, Poland
7Pediatric Center, Semmelweis University, Budapest, Hungary |
Correspondence:
Klára Horváth, Email: horvath.klara@gyerekklinika.com
|
|
Received: 15 November 2024 • Revised: 17 January 2025 • Accepted: 22 January 2025 |
|
|
| Abstract |
|
This study aimed to evaluate the effectiveness and safety of protocolized sedation in mechanically ventilated pediatric intensive care unit (PICU) patients. A comprehensive search was conducted in MEDLINE, CENTRAL, Embase, Web of Science, and Scopus from inception to October 18, 2023. Randomized controlled trials and observational studies that compared protocol-directed sedation management with conventional sedation regimens in pediatric patients who required invasive mechanical ventilation (IMV) for >24 h were included. Twenty-six studies (15,214 participants) were included. We found a statistically significant reduction in IMV duration (median difference [MD]=-13.88 h; 95% confidence interval [CI], -25.46 to -2.29; P=.022), PICU length of stay (MD=-0.64 days; 95% CI, -1.26 to -0.02; P=.045). We found significant reductions in the duration (MD= -1.28 days; 95% CI, -2.26 to -0.31; P=.016) and peak dose (MD=-0.05 mg/kg/h; 95% CI, -0.11 to 0.002; P=.044) of benzodiazepines. A significant increase was found in the odds of unplanned extubation (odds ratio=1.13; 95% CI, 1.02 to 1.26; P=.029). We found no significant results regarding the other outcomes. Our results suggest that protocolized sedation may reduce ventilation requirements and PICU length of stay; however, these findings were not confirmed by randomized controlled trials. Moreover, we observed a trend toward a reduction in sedative exposure and an increased odds of unplanned extubation. |
| Key Words:
Conscious sedation, Intensive care unit, Pediatrics, Critical care, Duration of therapy |
|
PDF Links
Download Citation
