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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 included 10 randomized controlled studies and 1 retrospective study for impact of sedation level on cognitive function. A total of 1216 participants were included with (M-H, Fixed 95% CI) and effect estimate 0.75 (0.63, 0.90) in statistical analysis. Heterogeneity was 64%, Chi² = 28.3, df = 10, (P = 0.002). Total overall effect or Z score of 3.09 with P = 0.002. The incidence of cognitive dysfunction was reported as 142/605 (23%) with the use of lower sedation scores and 183/611 (29%) with the use of higher sedation scores. There were 6 studies favoring cognitive dysfunction in high sedation group, 3 studies favoring cognitive dysfunction in low sedation group and 2 studies were neutral. Overall, higher sedation was associated with higher incidence of cognitive dysfunction with P value of 0.002. Subgroup difference was not significant with Chi² = 0.89, df=1, (P = 0.32) and I2 of zero (Figure 2 and 3).


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 included 10 randomized controlled studies and 1 retrospective study for impact of sedation level on cognitive function. A total of 1216 participants were included with (M-H, Fixed 95% CI) and effect estimate 0.75 (0.63, 0.90) in statistical analysis. Heterogeneity was 64%, Chi² = 28.3, df = 10, (P = 0.002). Total overall effect or Z score of 3.09 with P = 0.002. The incidence of cognitive dysfunction was reported as 142/605 (23%) with the use of lower sedation scores and 183/611 (29%) with the use of higher sedation scores. There were 6 studies favoring cognitive dysfunction in high sedation group, 3 studies favoring cognitive dysfunction in low sedation group and 2 studies were neutral. Overall, higher sedation was associated with higher incidence of cognitive dysfunction with P value of 0.002. Subgroup difference was not significant with Chi² = 0.89, df=1, (P = 0.32) and I2 of zero (Figure 2 and 3).

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