Nassar Antonio Paulo, Park Marcelo
Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.
Rev Bras Ter Intensiva. 2016 Oct-Dec;28(4):444-451. doi: 10.5935/0103-507X.20160078.
: The aim of this study was to systematically review studies that compared a mild target sedation protocol with daily sedation interruption and to perform a meta-analysis with the data presented in these studies.
: We searched Medline, Scopus and Web of Science databases to identify randomized clinical trials comparing sedation protocols with daily sedation interruption in critically ill patients requiring mechanical ventilation. The primary outcome was mortality in the intensive care unit.
: Seven studies were included, with a total of 892 patients. Mortality in the intensive care unit did not differ between the sedation protocol and daily sedation interruption groups (odds ratio [OR] = 0.81; 95% confidence interval [CI] 0.60 - 1.10; I2 = 0%). Hospital mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay did not differ between the groups either. Sedation protocols were associated with an increase in the number of days free of mechanical ventilation (mean difference = 6.70 days; 95%CI 1.09 - 12.31 days; I2 = 87.2%) and a shorter duration of hospital length of stay (mean difference = -5.05 days, 95%CI -9.98 - -0.11 days; I2 = 69%). There were no differences in regard to accidental extubation, extubation failure and the occurrence of delirium.
: Sedation protocols and daily sedation interruption do not appear to differ in regard to the majority of analyzed outcomes. The only differences found were small and had a high degree of heterogeneity.
本研究旨在系统回顾比较轻度目标镇静方案与每日镇静中断的研究，并对这些研究中呈现的数据进行荟萃分析。
我们检索了Medline、Scopus和Web of Science数据库，以识别比较镇静方案与每日镇静中断在需要机械通气的危重症患者中的随机临床试验。主要结局是重症监护病房的死亡率。
纳入了7项研究，共892例患者。镇静方案组和每日镇静中断组在重症监护病房的死亡率无差异（优势比[OR]=0.81；95%置信区间[CI]0.60 - 1.10；I²=0%）。两组在医院死亡率、机械通气时间、重症监护病房和住院时间方面也无差异。镇静方案与无机械通气天数增加相关（平均差=6.70天；95%CI 1.09 - 12.31天；I²=87.2%），且住院时间缩短（平均差=-5.05天，95%CI -9.98 - -0.11天；I²=69%）。在意外拔管、拔管失败和谵妄发生率方面无差异。
在大多数分析结局方面，镇静方案和每日镇静中断似乎没有差异。仅发现的差异较小且异质性程度较高。
