Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysis.

Abstract

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.