Background: Daily sedation interruption (DSI) has been proposed as a method of improving sedation management of critically ill patients by reducing the adverse effects of continuous sedation infusions. Different DSI protocols have been suggested with different drugs, discontinue duration and assessment instruments, and seem to lack a systemic guideline. Thus, it is vital to understand the effectiveness when carrying out DSI in adult ICU.
Objectives:The purpose of this review is to synthesise the effects of daily sedation interruption for adult ventilated patients in intensive care units.
Methods: We searched randomised clinical trials comparing sedation protocols with daily sedation interruption in critically ill patients requiring mechanical ventilation. The databases include: PubMed, CINAHL, Embase, the Cochrane Library and Chinese databases, covering the period between 1960 and March 2017. The relevance of papers selected for retrieval was assessed by 2 independent reviewers for adherence to the inclusion criteria. Additionally, the methodological quality of those studies that met the inclusion criteria were critically appraised by the 2 reviewers using the standardised critical-appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).
Results:Ten trials were included in the analysis (n = 1390 patients). There were not differ between DSI and non-DSI groups include: duration of mechanical ventilation, length of hospital stay, ICU mortality, the risk of self extubation, hospital mortality, reintubation within 48h-72h. DSI groups were associated with a decrease in the length of ICU stay (mean difference = -1.58 days; 95%CI [-3.16 – 0.01] days; I2 = 66%) and a lower risk of requiring tracheostomy (odds ratio [OR] = 0.67; 95%CI [0.50 – 0.91]; I2 = 0%).
Conclusions: We have found that DSI decrease the ICU stay and the risk of requiring tracheostomy. But there is no statistical difference in other results, so more research is needed to prove its clinical effectiveness.