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The Impact of High Versus Low Sedation Dosing Strategy on Cognitive Dysfunction in Survivors of Intensive Care Units: A Systematic Review and Meta-Analysis.

Porhomayon J, Joude P, Adlparvar G, El-Solh AA, Nader ND - J Cardiovasc Thorac Res (2015)

Bottom Line: We aim to demonstrate that high sedation strategy will result in change of mental health function in ICU patients.We included 11 studies in the final analysis and concluded that high dose sedation strategy resulted in higher incidence of cognitive dysfunction with P value of 0.009.Overall analysis was statistically significant with a P value of 0.002.

View Article: PubMed Central - HTML - PubMed

Affiliation: VA Western New York Healthcare System, Division of Critical Care Medicine, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA.

ABSTRACT

Background: The practice of low vs. high sedation dosing strategy may impact the cognitive and mental health function in the intensive care unit (ICU). We aim to demonstrate that high sedation strategy will result in change of mental health function in ICU patients.

Methods: We performed a systemic search and meta-analysis of medical databases in MEDLINE (from 1966 to March 2013) and EMBASE (from 1980 to March 2013), as well as the Cochrane Library using the MESH terms "Intensive Care Unit," and "Mental Health, for assessing the impact of sedation on posttraumatic stress disorder (PTSD) or anxiety/depression and delirium in the mix ICU setting including cardiac surgery patients. A total of 1216 patients were included in the final analysis.

Results: We included 11 studies in the final analysis and concluded that high dose sedation strategy resulted in higher incidence of cognitive dysfunction with P value of 0.009. The result for subgroup of delirium showed P = 0.11 and PTSD/depression or anxiety of P = 0.001, Heterogeneity I2 was 64%. Overall analysis was statistically significant with a P value of 0.002.

Conclusion: High sedation dosing strategy will negatively affect cognitive function in critically ill patients. Large randomized trials are needed to address cognitive dysfunction in subgroup of patients with delirium.

No MeSH data available.


Related in: MedlinePlus

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Mentions: We searched the electronic databases MEDLINE (from 1966 to March 2013) and EMBASE (from 1980 to March 2013), as well as the Cochrane Library using the MESH terms “Intensive Care Unit,” and “Mental Health”. We further narrowed the search by using the filters “post-traumatic stress disorders, “sedation,” “delirium” and “anxiety or depression”. Furthermore, we reviewed reference lists of original and reviewed articles to search for more studies. Only those studies that were published as full-length articles were considered. No language restriction was applied. When confronted with different time interval for evaluation of cognitive dysfunction, months after discharge was considered for final analysis rather than evaluation at the time of discharge from ICU (Figure 1). After careful examination of titles and abstracts, a total of 753 citations were identified from databases. Additional 37 articles were identified through search from other databases and from the references of 753 articles. Twelve records were excluded for duplication or repetition. 778 records were screened. Narrowing the search for delirium and PTSD/depression or agitation yielded 227 articles. Two authors evaluated 227 articles independently and 14 articles were included for analysis. One prospective trial and two retrospective studies were excluded because sedation scores were not reported. Furthermore, we also reviewed the reference lists of the selected 10 studies to search for additional trials. Finally, 10 prospective randomized controlled trials (RCTs) and one observational study were identified for analysis (Figure 1).


The Impact of High Versus Low Sedation Dosing Strategy on Cognitive Dysfunction in Survivors of Intensive Care Units: A Systematic Review and Meta-Analysis.

Porhomayon J, Joude P, Adlparvar G, El-Solh AA, Nader ND - J Cardiovasc Thorac Res (2015)

© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492176&req=5

Mentions: We searched the electronic databases MEDLINE (from 1966 to March 2013) and EMBASE (from 1980 to March 2013), as well as the Cochrane Library using the MESH terms “Intensive Care Unit,” and “Mental Health”. We further narrowed the search by using the filters “post-traumatic stress disorders, “sedation,” “delirium” and “anxiety or depression”. Furthermore, we reviewed reference lists of original and reviewed articles to search for more studies. Only those studies that were published as full-length articles were considered. No language restriction was applied. When confronted with different time interval for evaluation of cognitive dysfunction, months after discharge was considered for final analysis rather than evaluation at the time of discharge from ICU (Figure 1). After careful examination of titles and abstracts, a total of 753 citations were identified from databases. Additional 37 articles were identified through search from other databases and from the references of 753 articles. Twelve records were excluded for duplication or repetition. 778 records were screened. Narrowing the search for delirium and PTSD/depression or agitation yielded 227 articles. Two authors evaluated 227 articles independently and 14 articles were included for analysis. One prospective trial and two retrospective studies were excluded because sedation scores were not reported. Furthermore, we also reviewed the reference lists of the selected 10 studies to search for additional trials. Finally, 10 prospective randomized controlled trials (RCTs) and one observational study were identified for analysis (Figure 1).

Bottom Line: We aim to demonstrate that high sedation strategy will result in change of mental health function in ICU patients.We included 11 studies in the final analysis and concluded that high dose sedation strategy resulted in higher incidence of cognitive dysfunction with P value of 0.009.Overall analysis was statistically significant with a P value of 0.002.

View Article: PubMed Central - HTML - PubMed

Affiliation: VA Western New York Healthcare System, Division of Critical Care Medicine, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA.

ABSTRACT

Background: The practice of low vs. high sedation dosing strategy may impact the cognitive and mental health function in the intensive care unit (ICU). We aim to demonstrate that high sedation strategy will result in change of mental health function in ICU patients.

Methods: We performed a systemic search and meta-analysis of medical databases in MEDLINE (from 1966 to March 2013) and EMBASE (from 1980 to March 2013), as well as the Cochrane Library using the MESH terms "Intensive Care Unit," and "Mental Health, for assessing the impact of sedation on posttraumatic stress disorder (PTSD) or anxiety/depression and delirium in the mix ICU setting including cardiac surgery patients. A total of 1216 patients were included in the final analysis.

Results: We included 11 studies in the final analysis and concluded that high dose sedation strategy resulted in higher incidence of cognitive dysfunction with P value of 0.009. The result for subgroup of delirium showed P = 0.11 and PTSD/depression or anxiety of P = 0.001, Heterogeneity I2 was 64%. Overall analysis was statistically significant with a P value of 0.002.

Conclusion: High sedation dosing strategy will negatively affect cognitive function in critically ill patients. Large randomized trials are needed to address cognitive dysfunction in subgroup of patients with delirium.

No MeSH data available.


Related in: MedlinePlus