Department of Intensive Care Unit, Hebei General Hospital, Shijiazhuang City, Hebei Province, China.
SICU, the 8th Medical Center, General Hospital of PLA, Beijing City, China.
PLoS One. 2020 Jul 16;15(7):e0236014. doi: 10.1371/journal.pone.0236014. eCollection 2020.
Delirium is multifactorial. This study aimed at determining the association between different depths of sedation and the risk of delirium in adult mechanically ventilated patients.
A systematic literature retrieval was conducted in databases including Cochrane Central Register of Controlled Trials, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature for publications available till December 2019 without limitation in study type, and followed by a secondary retrieval for related literature. STATA15.1 and WinBugs 14.3 were used in statistical analyses for different sedation depths as the intervention. The main endpoint was delirium occurrence. Secondary endpoints were agitation-related adverse events and mortality.
We included 18 studies comprising 8001 mechanically ventilated patients. Different sedation depths were not associated with the occurrence of delirium (OR = 1.00, 95%CI: 0.64-1.58, P = 0.993). Among the 18 enrolled studies, this finding was not confounded by the dosage of benzodiazepines (OR = 0.96, 95%CI: 0.79-1.17, P = 0.717) in eight randomized controlled trials(RCTs) or the patients' disease severity(OR 0.95, 95%CI: 0.79-1.13, P = 0.548) in 10 RCTs. However, contrasting results were found in non-RCTs. The deeper sedation group had a significantly increased risk for death(OR = 1.82, 95% CI: 1.23-2.69, P = 0.003), whereas lighter sedation seemed a potential risk for agitation-related adverse events (OR = 0.61, 95%CI: 0.45-0.84, P = 0.002).
It is inconclusive whether significantly different sedation depths would change the risk of delirium in adult mechanically ventilated patients.
The study was registered in PROSPERO(http://www.crd.york.ac.uk/PROSPERO/) under registration number CRD42019145276.
谵妄是多因素的。本研究旨在确定不同镇静深度与成人机械通气患者谵妄风险之间的关系。
系统检索 Cochrane 对照试验中心注册数据库、PubMed、Embase 和 Cumulative Index to Nursing and Allied Health Literature 中截至 2019 年 12 月的文献，不限制研究类型，并对相关文献进行二次检索。STATA15.1 和 WinBugs14.3 用于不同镇静深度作为干预的统计分析。主要终点是谵妄发生。次要终点是激越相关不良事件和死亡率。
我们纳入了 18 项研究，共纳入 8001 例机械通气患者。不同的镇静深度与谵妄的发生无关（OR=1.00，95%CI：0.64-1.58，P=0.993）。在纳入的 18 项研究中，这一发现不受 8 项随机对照试验（RCT）中苯二氮䓬类药物剂量（OR=0.96，95%CI：0.79-1.17，P=0.717）或 10 项 RCT 中患者疾病严重程度（OR 0.95，95%CI：0.79-1.13，P=0.548）的混杂。然而，在非 RCT 中则得出了相反的结果。深度镇静组的死亡风险显著增加（OR=1.82，95%CI：1.23-2.69，P=0.003），而浅度镇静似乎与激越相关不良事件的风险增加有关（OR=0.61，95%CI：0.45-0.84，P=0.002）。
在成人机械通气患者中，不同的镇静深度是否会改变谵妄的风险尚无定论。
该研究在 PROSPERO（http://www.crd.york.ac.uk/PROSPERO/）上进行了注册，注册号为 CRD42019145276。
