PhD Scientific Days 2022

Budapest, 6-7 July 2022

Clinical Medicine III.

The Effectiveness and Safety of Protocolized Sedation in the Pediatric Intensive Care Unit

Ambrus Szemere1,2, Klementina Ocskay1,3, Fanni Dembrovszky1,3, László Szabó1,3, Anna Réka Sebestyén1,4, Péter Hegyi1,5,6, Tamás Terebessy1,7, Rani Ezzeddine1, Zsolt Molnár1,2,8, Klára Horváth1,9

1 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
2 Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
3 Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
4 Heim Pál National Pediatric Institute, Budapest, Hungary
5 Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
6 Division for Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
7 Department of Orthopaedics, Semmelweis University, Budapest, Hungary
8 Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Poznan, University of Medical Sciences, Poznan, Poland
9 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary

Text of the abstract

Mechanically ventilated patients in the pediatric ICU (PICU) require sedation to facilitate care, minimize discomfort, reduce the risk of self-injury and to ensure humane treatment. However, oversedation can prolong duration of ventilation and ICU stay, which may compromise overall recovery. Implementation of novel strategies to minimize sedative exposure and to optimize sedation management are crucial to improve treatment of the critically ill.

We conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of protocol-directed sedation management compared to conventional sedation management in the mechanically ventilated PICU population.

We performed a comprehensive search in 5 medical databases on October 9, 2021. Included studies compared protocol-directed sedation management to conventional sedation regimen in critically ill pediatric patients requiring invasive mechanical ventilation (IMV). The GRADE method was used to assess certainty of evidence. Our main outcomes were the duration of IMV, ICU length of stay (LOS), in-hospital LOS, ICU mortality and the incidence of adverse events. Pooled odds ratios (OR) for binary outcomes and mean differences (MD) for continuous outcomes with 95% CIs were calculated using a random-effects model.

We included 18 studies (2 cluster and 2 pilot RCTs, 7 prospective and 7 retrospective cohort studies) with a total of 13703 participants comparing protocolized sedation to conventional care. There was no clear evidence of difference in duration of IMV (MD -6.52 hours, 95% CI -18.01 to 4,97; I2 =46%), in ICU LOS (MD -0.60 days, 95% CI -1.72 to 0.51; I2 =60%), in in-hospital LOS (MD -0.77 days, 95% CI -2.74 to 1.20; I2 =86%) and in ICU mortality (OR 1.13, 95% CI 0.92 to 1.37; I2 =0%). We found no significant difference in the incidence of adverse events.

Our results did not show superiority of protocolized sedation regarding our main outcomes; however, the reported high degree of statistical heterogeneity limited the interpretation of our results. Further RCTs need to be conducted to produce sufficient, high-quality evidence assessing the effectiveness of protocol-directed sedation in the PICU population.