Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysis
This study aimed to evaluate the effectiveness and safety of protocolized sedation in mechanically ventilated pediatric intensive care unit (PICU) patients. A comprehensive search was conducted in MEDLINE, CENTRAL, Embase, Web of Science, and Scopus from inception to October 18, 2023. Randomized con...
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| Format: | Article |
| Language: | English |
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The Korean Pediatric Society
2025-06-01
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| Series: | Clinical and Experimental Pediatrics |
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| Online Access: | http://e-cep.org/upload/pdf/cep-2024-01711.pdf |
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| author | Ambrus Szemere Alíz Fazekas Anna Réka Sebestyén Rani Ezzeddine Veronika Upor Marie Anne Engh Péter Hegyi Zsolt Molnár Klára Horváth |
| author_facet | Ambrus Szemere Alíz Fazekas Anna Réka Sebestyén Rani Ezzeddine Veronika Upor Marie Anne Engh Péter Hegyi Zsolt Molnár Klára Horváth |
| author_sort | Ambrus Szemere |
| collection | DOAJ |
| description | This study aimed to evaluate the effectiveness and safety of protocolized sedation in mechanically ventilated pediatric intensive care unit (PICU) patients. A comprehensive search was conducted in MEDLINE, CENTRAL, Embase, Web of Science, and Scopus from inception to October 18, 2023. Randomized controlled trials (RCTs) and observational studies that compared protocol-directed sedation management with conventional sedation regimens in pediatric patients who required invasive mechanical ventilation (IMV) for >24 hours were included. Twenty-six studies (15,214 participants) were included. We found a statistically significant reduction in IMV duration (median difference [MD]=-13.88 hours; 95% confidence interval [CI], -25.46 to -2.29; P=0.022), PICU length of stay (MD=-0.64 days; 95% CI, -1.26 to -0.02; P=0.045). We found significant reductions in the duration (MD=-1.28 days; 95% CI, -2.26 to -0.31; P=0.016) and peak dose (MD=-0.05 mg/kg/hr 95% CI, -0.11 to 0.002; P=0.044) of benzodiazepines. A significant increase was found in the odds of unplanned extubation (odds ratio, 1.13; 95% CI, 1.02 to 1.26; P=0.029). We found no significant results regarding the other outcomes. Our results suggest that protocolized sedation may reduce ventilation requirements and PICU length of stay; however, these findings were not confirmed by RCTs. Moreover, we observed a trend toward a reduction in sedative exposure and an increased odds of unplanned extubation. |
| format | Article |
| id | doaj-art-e6415addddf94211b0771927a3e231c2 |
| institution | OA Journals |
| issn | 2713-4148 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | The Korean Pediatric Society |
| record_format | Article |
| series | Clinical and Experimental Pediatrics |
| spelling | doaj-art-e6415addddf94211b0771927a3e231c22025-08-20T02:03:20ZengThe Korean Pediatric SocietyClinical and Experimental Pediatrics2713-41482025-06-0168640641610.3345/cep.2024.0171120125555788Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysisAmbrus Szemere0Alíz Fazekas1Anna Réka Sebestyén2Rani Ezzeddine3Veronika Upor4Marie Anne Engh5Péter Hegyi6Zsolt Molnár7Klára Horváth8 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary Centre for Translational Medicine, Semmelweis University, Budapest, Hungary Centre for Translational Medicine, Semmelweis University, Budapest, Hungary Centre for Translational Medicine, Semmelweis University, Budapest, Hungary Centre for Translational Medicine, Semmelweis University, Budapest, Hungary Centre for Translational Medicine, Semmelweis University, Budapest, Hungary Centre for Translational Medicine, Semmelweis University, Budapest, Hungary Centre for Translational Medicine, Semmelweis University, Budapest, HungaryThis study aimed to evaluate the effectiveness and safety of protocolized sedation in mechanically ventilated pediatric intensive care unit (PICU) patients. A comprehensive search was conducted in MEDLINE, CENTRAL, Embase, Web of Science, and Scopus from inception to October 18, 2023. Randomized controlled trials (RCTs) and observational studies that compared protocol-directed sedation management with conventional sedation regimens in pediatric patients who required invasive mechanical ventilation (IMV) for >24 hours were included. Twenty-six studies (15,214 participants) were included. We found a statistically significant reduction in IMV duration (median difference [MD]=-13.88 hours; 95% confidence interval [CI], -25.46 to -2.29; P=0.022), PICU length of stay (MD=-0.64 days; 95% CI, -1.26 to -0.02; P=0.045). We found significant reductions in the duration (MD=-1.28 days; 95% CI, -2.26 to -0.31; P=0.016) and peak dose (MD=-0.05 mg/kg/hr 95% CI, -0.11 to 0.002; P=0.044) of benzodiazepines. A significant increase was found in the odds of unplanned extubation (odds ratio, 1.13; 95% CI, 1.02 to 1.26; P=0.029). We found no significant results regarding the other outcomes. Our results suggest that protocolized sedation may reduce ventilation requirements and PICU length of stay; however, these findings were not confirmed by RCTs. Moreover, we observed a trend toward a reduction in sedative exposure and an increased odds of unplanned extubation.http://e-cep.org/upload/pdf/cep-2024-01711.pdfconscious sedationintensive care unitpediatricscritical careduration of therapy |
| spellingShingle | Ambrus Szemere Alíz Fazekas Anna Réka Sebestyén Rani Ezzeddine Veronika Upor Marie Anne Engh Péter Hegyi Zsolt Molnár Klára Horváth Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysis Clinical and Experimental Pediatrics conscious sedation intensive care unit pediatrics critical care duration of therapy |
| title | Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysis |
| title_full | Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysis |
| title_fullStr | Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysis |
| title_full_unstemmed | Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysis |
| title_short | Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysis |
| title_sort | protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit a systematic review and meta analysis |
| topic | conscious sedation intensive care unit pediatrics critical care duration of therapy |
| url | http://e-cep.org/upload/pdf/cep-2024-01711.pdf |
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