Meta-analysis of randomised controlled trials on daily sedation interruption for critically ill adult patients

Intensive Care Unit, Royal Perth Hospital and School of Population Health, University of Western Australia, Perth, Western Australia, Australia.
Anaesthesia and intensive care (Impact Factor: 1.3). 05/2011; 39(3):401-9.
Source: PubMed


Sedation is often used to improve comfort, reduce anxiety and stress and to facilitate nursing care of critically ill patients in the intensive care unit. This meta-analysis examined the benefits and risks of daily sedation interruption in critically ill adult patients. A total of five randomised controlled trials, comparing daily sedation interruption with no interruption in 699 critically ill patients, from the Cochrane controlled trials register, Embase and MEDLINE databases (1966 to April 2010) were identified and subject to meta-analysis. With the limited data available, daily sedation interruption was not associated with a significant reduction in duration of mechanical ventilation, length of intensive care unit and hospital stay, or mortality. Daily sedation interruption was associated with a reduced risk of requiring tracheostomy (odds ratio 0.57, 95% confidence interval 0.35 to 0.92, P = 0.02; F = 3%) but not an increased risk of removal of the endotracheal tube by the patients (odds ratio 1.3, 95% confidence interval 0.41 to 4.10, P = 0.65; F = 49%). The current evidence suggests that daily sedation interruption appears to be safe, but the significant heterogeneity and small sample sizes of the existing studies suggest that large randomised controlled studies with long-term survival follow-up are needed before daily sedation interruption can be recommended as a standard sedation practice for critically ill adult patients.

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    • "However, others have shown that interrupting sedation on a daily basis can increase the rate of unplanned extubation, causing long-term psychological complications in these patients. Consequently, the application of the daily interruption of sedation has not been used extensively [4]. This study analysed randomized controlled trials on daily interruption of sedation using metaanalysis . "
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    ABSTRACT: To evaluate the effectiveness of daily sedation interruption in patients with mechanical ventilation in intensive care unit (ICU).
    Full-text · Article · Nov 2014
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    • "Follow-up studies showed that DSI reduces the incidence of complications associated with mechanical ventilation and reduced symptoms of post-traumatic-stress disorder (PTSD) [7,8]. In the last few years, some studies have confirmed the safety and efficacy of DSI [9,10], while other studies did not find a positive effect of DSI on clinical outcome [11,12]. Nevertheless, DSI is now routine practice in adult ICUs [5,13]. "
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    ABSTRACT: Background In adult patients who are critically ill and mechanically ventilated, daily interruption of sedation (DSI) is an effective method of improving sedation management, resulting in a decrease of the duration of mechanical ventilation, the length of stay in the intensive care unit (ICU) and the length of stay in the hospital. It is a safe and effective approach and is common practice in adult ICUs. For critically ill children it is unknown if DSI is effective and feasible. The aim of this multicenter randomized controlled trial is to evaluate the safety and efficacy of daily sedation interruption in critically ill children. Methods/Design Children between 0 and 18 years of age who require mechanical ventilation, with an expected duration of at least 48 h and need for sedative infusion, will be included. After enrollment patients will be randomly assigned to DSI in combination with protocolized sedation (intervention group) or protocolized continuous sedation (control group). A sedation protocol that contains an algorithm for increasing and weaning of sedatives and analgesics will be used. The sedative infusion will be restarted if the patient becomes uncomfortable or agitated according to the sedation protocol. The primary endpoint is the number of ventilator-free days at 28 days. Trial registration NTR2030
    Full-text · Article · Feb 2014 · Trials
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    • "Of note, because one meta-analysis [34] included seven trials conducted by Joachim Boldt that had been retracted [36], Boldt's trials were excluded from analysis. Eight meta-analyses [10,13,17,18,25,28,31,34] included only one large trial, and the meta-analyses by Zhongheng [35] included mostly large trials (83.3%). Most meta-analyses reported non-significant effect size, and only six meta-analyses [19,20,22,25,30,31] reported statistically significant effect sizes (for example mortality). "
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    ABSTRACT: Introduction Small-study effects refer to the fact that trials with limited sample sizes are more likely to report larger beneficial effects than large trials. However, this has never been investigated in critical care medicine. Thus, the present study aimed to examine the presence and extent of small-study effects in critical care medicine. Methods Critical care meta-analyses involving randomized controlled trials and reported mortality as an outcome measure were considered eligible for the study. Component trials were classified as large (≥100 patients per arm) and small (<100 patients per arm) according to their sample sizes. Ratio of odds ratio (ROR) was calculated for each meta-analysis and then RORs were combined using a meta-analytic approach. ROR<1 indicated larger beneficial effect in small trials. Small and large trials were compared in methodological qualities including sequence generating, blinding, allocation concealment, intention to treat and sample size calculation. Results A total of 27 critical care meta-analyses involving 317 trials were included. Of them, five meta-analyses showed statistically significant RORs <1, and other meta-analyses did not reach a statistical significance. Overall, the pooled ROR was 0.60 (95% CI: 0.53 to 0.68); the heterogeneity was moderate with an I2 of 50.3% (chi-squared = 52.30; P = 0.002). Large trials showed significantly better reporting quality than small trials in terms of sequence generating, allocation concealment, blinding, intention to treat, sample size calculation and incomplete follow-up data. Conclusions Small trials are more likely to report larger beneficial effects than large trials in critical care medicine, which could be partly explained by the lower methodological quality in small trials. Caution should be practiced in the interpretation of meta-analyses involving small trials.
    Full-text · Article · Jan 2013 · Critical care (London, England)
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