Minhas Mahad A, Velasquez Adrian G, Kaul Anubhav, Salinas Pedro D, Celi Leo A
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH.
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH; Department of Critical Care, Newport Hospital, Newport, RI; Department of Medicine-Section of Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Mayo Clin Proc. 2015 May;90(5):613-23. doi: 10.1016/j.mayocp.2015.02.016. Epub 2015 Apr 9.
To assess the effects of protocolized sedation (algorithm or daily interruption) compared with usual care without protocolized sedation on clinical outcomes in mechanically ventilated adult intensive care unit (ICU) patients via a systematic review and meta-analysis of randomized controlled trials (RCTs).
We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov from their inception to February 28, 2013. A random-effects model was used to synthesize risk ratios (RRs) and weighted mean differences (WMDs).
Of 4782 records screened, 6 RCTs including 1243 patients met the inclusion criteria. Protocolized sedation was associated with significant reductions in overall mortality (RR, 0.85; 95% CI, 0.74 to 0.97; P=.02; number needed to treat, 20; P=.11), ICU length of stay (WMD, -1.73 days; 95% CI, -3.32 to -0.14 days; P=.03), hospital length of stay (WMD, -3.55 days; 95% CI, -5.98 to -1.12 days; P=.004), and tracheostomy (RR, 0.69; 95% CI, 0.50 to 0.96; P=.03; number needed to treat, 16.6; P=.04; 5 RCTs) compared with usual care. Protocolized sedation produced no significant differences in duration of mechanical ventilation (WMD, -1.04 days; 95% CI, -2.54 to 0.47 days; P=.18), reintubation (RR, 0.78; 95% CI, 0.52 to 1.15; P=.21; 3 RCTs), and self-extubation (RR, 1.49; 95% CI, 0.46 to 4.82; P=.51; 4 RCTs) compared with usual care. Included studies did not report delirium incidence.
In mechanically ventilated adults in closed, nonspecialty ICUs, protocolized sedation seems to decrease overall mortality (15%), ICU and hospital lengths of stay (1.73 and 3.55 days, respectively), and tracheostomy (31%) compared with usual care without protocolized sedation.
通过对随机对照试验（RCT）的系统评价和荟萃分析，评估与未采用规范化镇静的常规护理相比，规范化镇静（采用算法或每日中断）对机械通气的成年重症监护病房（ICU）患者临床结局的影响。
我们检索了Ovid MEDLINE、EMBASE、Cochrane CENTRAL、Web of Science和ClinicalTrials.gov，检索时间从各数据库建库至2013年2月28日。采用随机效应模型综合风险比（RRs）和加权均数差（WMDs）。
在筛选的4782条记录中，6项RCT（共1243例患者）符合纳入标准。与常规护理相比，规范化镇静可显著降低总体死亡率（RR=0.85；95%CI：0.74至0.97；P=0.02；需治疗人数=20；P=0.11）、ICU住院时间（WMD=-1.73天；95%CI：-3.32至-0.14天；P=0.03）、医院住院时间（WMD=-3.55天；95%CI：-5.98至-1.12天；P=0.004）以及气管切开术发生率（RR=0.69；95%CI：0.50至0.96；P=0.03；需治疗人数=16.6；P=0.04；5项RCT）。与常规护理相比，规范化镇静在机械通气时间（WMD=-1.04天；95%CI：-2.54至0.47天；P=0.18）、再次插管率（RR=0.78；95%CI：0.52至1.15；P=0.21；3项RCT）和自行拔管率（RR=1.49；95%CI：0.46至4.82；P=0.51；4项RCT）方面无显著差异。纳入研究未报告谵妄发生率。
在封闭式非专科ICU中接受机械通气的成年人中，与未采用规范化镇静的常规护理相比，规范化镇静似乎可降低总体死亡率（15%）、ICU和医院住院时间（分别为1.73天和3.55天）以及气管切开术发生率（31%）。
