Sedative drugs used for mechanically ventilated patients in intensive care units: a systematic review and network meta-analysis

Wang, Hongliang; Wang, Changsong; Wang, Yue; Tong, Hongshuang; Feng, Yue; Li, Ming; Jia, Lianshun; Yu, Kaijiang

doi:10.1080/03007995.2018.1509573

Cited by 23 publications

(17 citation statements)

References 58 publications

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“…There are multiple mechanisms by which dexmedetomidine may reduce the incidence of lung injury and thus lead to a lower rate of mortality than other sedatives. In patients with sepsis, sedation with dexmedetomidine was associated with lower rates and shorter durations of coma and delirium (Riker et al, 2009;Pandharipande et al, 2010;Skrobik et al, 2018;Wang et al, 2019), both of which are independently associated with an increased mortality rate and prolonged hospitalization duration (Ely et al, 2004;Pisani et al, 2009;Shehabi et al, 2010;Shi et al, 2019). Additionally, respiratory drive affects the pathophysiology and clinical outcome of ARDS (Spinelli et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Midazolam, Propofol, and Dexmedetomidine in Patients With or at Risk for Acute Respiratory Distress Syndrome: A Propensity Score-Matched Cohort Study

Zhong

et al. 2021

Front. Pharmacol.

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Background: Sedatives are commonly used in patients with or at risk for acute respiratory distress syndrome (ARDS) during mechanical ventilation. To systematically compare the outcomes of sedation with midazolam, propofol, and dexmedetomidine in patients with or at risk for ARDS.Methods: We developed a dataset of real-world data to enable the comparison of the effectiveness and safety of sedatives and the associated outcomes from the MIMIC-III database and the eICU Collaborative Research database. We performed a systematic study with six cohorts to estimate the relative risks of outcomes among patients administered different sedatives. Propensity score matching was performed to generate a balanced 1:1 matched cohort and to identify potential prognostic factors. The outcomes included hospital mortality, duration of mechanical ventilation, length of intensive care unit stay, length of hospitalization, and likelihood of being discharged home.Results: We performed 60 calibrated analyses among all groups and outcomes with 17,410 eligible patients. Sedation with dexmedetomidine was associated with a lower in-hospital mortality rate than sedation with midazolam and propofol or sedation without dexmedetomidine (p < 0.001). When compared with no sedation, the use of midazolam, propofol or dexmedetomidine was associated with a longer ICU stay and longer hospitalization duration (p < 0.01). Patients treated with midazolam were relatively less likely to be discharged home (p < 0.05).Conclusion: Patients treated with dexmedetomidine had a reduced risk of mortality. These data suggest that dexmedetomidine may be the preferred sedative in patients with or at risk for ARDS.

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Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Midazolam, Propofol, and Dexmedetomidine in Patients With or at Risk for Acute Respiratory Distress Syndrome: A Propensity Score-Matched Cohort Study

Zhong

et al. 2021

Front. Pharmacol.

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“…The fact that benzodiazepines given regularly are associated with prolonging the time of dischargeability is consistent with previous literature that has found benzodiazepines to be a risky treatment for the geriatric population ( 28 ) and results in increased length of hospital stay. ( 29 )…”

Section: Discussionmentioning

confidence: 99%

Management of Agitation in Dementia and Effects on Inpatient Length of Stay

Silverstone-Simard

Nassim

et al. 2021

Can Geri J

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Background Agitation associated with dementia impacts delivery of medical care and is a major reason for institutionalization in dementia patients. This study examines the association of medication use and other clinical factors with patients’ ‘dischargeability’ (i.e., amount of time until a patient is considered dischargeable from an inpatient unit). Methods This study was a retrospective chart review examining 200 patients with dementia and agitation, hospitalized at a Canadian acute care geriatric ward between November 2007 and November 2018. The main outcome measure was time until a patient was deemed dischargeable. Univariate linear regression analyses, followed by multiple linear regression analyses, were used. Results Risperidone and quetiapine were the most commonly prescribed medications, but were not associated with time until dischargeable. Olanzapine (40.9 vs. 16.2 days until dischargeable, β = 0.23, p = .001), regular benzodiazepine (32.7 vs. 16.5 days until dischargeable, β = 0.15, p = .027), and as-needed (‘PRN’) benzodiazepine use (31.7 vs. 15.9 days until dischargeable, β =0.19, p = .006) were independently associated with prolonging time until dischargeable. Conclusions Olanzapine, benzodiazepine, and PRN benzodiazepine use were associated with longer time until patients with dementia and agitation were considered ready for discharge. This raises the question as to whether the risks of these medications outweigh the benefits in a hospital setting.

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“…Pacientes internados em UTI adulto geralmente são graves e podem necessitar de suporte ventilatório e de sedação; além disso, podem apresentar quadros dolorosos e, deste modo, a administração de sedativos, hipnóticos, analgésico e/ou opioides é fundamental para proporcionar conforto ao paciente, reduzir o estresse e evitar retardo na recuperação [21][22][23] . Por outro lado, estes medicamentos são classificados como potencialmente perigosos por sua alta probabilidade de acarretar eventos adversos e dano ao paciente 7,24,25 .…”

Section: Discussionunclassified

Fatores associados para potenciais interações medicamentosas clinicamente significantes em terapia intensiva adulto

Moraes

Maia

Trindade

et al. 2020

Medicina (Ribeirão Preto)

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Modelo do estudo: Estudo transversal. Objetivo: caracterizar as interações medicamentosas potenciais (IMp) maiores e contraindicadas em terapia intensiva adulto e determinar sua prevalência, medicamentos e fatores associados à exposição dessas interações. Métodos: a amostra foi composta por 309 pacientes internados em uma unidade de terapia intensiva adulto de um hospital da Região Centro-Oeste de Minas Gerais, Brasil. Os dados demográficos-clínicos e perfil medicamentoso foram coletados, prospectivamente. As IMp foram caracterizadas pela base Micromedex 2.0 quanto à gravidade, prevalência e implicação clínica. Realizaram-se análises descritivas para as variáveis qualitativas e contínuas. Modelos Lineares Generalizados com distribuição Gama e Poisson foram utilizados para avaliar a relação entre um conjunto de variáveis independentes e a prevalência de IMp maiores e contraindicadas (p<0.05). Resultados: Um total de 81,8% (n=251) foi exposto a, no mínimo, uma IMp maior ou contraindicada. Mais de um terço (37,4%) destes participantes foram expostos a seis ou mais IMp. Medicamentos com ação no sistema nervoso colaboraram para maior probabilidade de IMp maiores e/ou contraindicadas. Pessoas idosas (p=0,006), do sexo masculino (p=0,028) e polimedicadas (<0,001) tiveram maior probabilidade de serem expostas ao menos a uma IMp maior ou contraindicada. Conclusão: Interações medicamentosas potenciais maiores e contraindicadas apresentaram alta frequência. Pessoas idosas, do sexo masculino e polimedicadas foram mais expostas às IMp maiores e/ou contraindicadas. É importante que profissionais da saúde conheçam os riscos e potenciais eventos adversos relacionados às IMp maiores e contraindicadas, para que sejam implementadas medidas para promoção da segurança do paciente.

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Sedative drugs used for mechanically ventilated patients in intensive care units: a systematic review and network meta-analysis

Abstract: Compared to propofol, benzodiazepines may increase the duration of ICU stay. Compared to alpha agonists, benzodiazepines were associated with an increased risk of delirium.

Cited by 23 publications

References 58 publications

Comparative Effectiveness of Midazolam, Propofol, and Dexmedetomidine in Patients With or at Risk for Acute Respiratory Distress Syndrome: A Propensity Score-Matched Cohort Study

Comparative Effectiveness of Midazolam, Propofol, and Dexmedetomidine in Patients With or at Risk for Acute Respiratory Distress Syndrome: A Propensity Score-Matched Cohort Study

Management of Agitation in Dementia and Effects on Inpatient Length of Stay

Fatores associados para potenciais interações medicamentosas clinicamente significantes em terapia intensiva adulto

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