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Review Article

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 Sebestyén^1,3, Rani Ezzeddine¹, Veronika Upor¹, Marie Anne Engh¹, Péter Hegyi^1,2,4, Zsolt Molnár^1,5,6, 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: November 15, 2024; Revised: January 17, 2025   Accepted: January 22, 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.

Keywords :Conscious sedation, Intensive care unit, Pediatrics, Critical care, Duration of therapy