Sedative drugs used for mechanically ventilated patients in intensive care units: a systematic review and network meta-analysis

<p><b>Background:</b> The effects of different sedative drugs on all-cause mortality rate, duration of ICU stay, and risk of delirium in mechanically ventilated ICU patients are unclear. This meta-analysis aimed to compare the effectiveness and safety of individual sedative drugs and drug combinations in mechanically ventilated ICU patients.</p> <p><b>Materials and methods:</b> Medline, Embase, Cochrane, EBSCOhost, and ISI Web of Science databases were searched for studies that assessed sedation in ICU mechanically ventilated patients. A Bayesian random-effects model was used to combine the direct comparisons and indirect evidence.</p> <p><b>Results:</b> Thirty-one randomized, controlled trials were included, which consisted of 4491 patients who received one of seven sedative drugs or a combination of drugs. There were no significant differences regarding the all-cause mortality rate. Compared to propofol, inhalation anesthetics (hazard ratio [HR] 0.121; 95% credible interval [CrI] -7.58 to 7.62), alpha agonists (HR 2.2; 95% CrI 0.776 to 5.22), propofol with benzodiazepines (HR 0.306; 95% CrI -6.97 to 7.65), ketamine with benzodiazepines (HR 6.57; 95% CrI -6.05 to 19.1) and placebo (HR 2.4; 95% CrI -5.37 to 10.3), benzodiazepines (HR 3.62; 95% CrI 0.834 to 6.2) may increase the duration of ICU stay. Compared to alpha agonists, propofol (HR 2.4; 95% CrI 0.304 to 21.1) and placebo (HR 6.12; 95% CrI 0.745 to 54.6), benzodiazepines (HR 2.59; 95% CrI 1.08 to 7.4) were associated with incremental risks of delirium.</p> <p><b>Conclusion:</b> Compared to propofol, benzodiazepines may increase the duration of ICU stay. Compared to alpha agonists, benzodiazepines were associated with an increased risk of delirium.</p

Salvia ranzaniana Makino

原著和名: ハルノタムラサウ科名: シソ科 = Labiatae採集地: 奈良県 玉置山 (大和 玉置山)採集日: 1982/5/16採集者: 萩庭丈壽整理番号: JH031613国立科学博物館整理番号: TNS-VS-98161

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Additional file 12. 1. Sensitivity analysis for the rate of CRBSIs per 1000 catheter-days to evaluate the contribution of individual studies to the global results; 2. Sensitivity analyses for the rate of CRBSIs per 1000 catheter-days; 3. Sensitivity analysis for catheter colonization to evaluate the contribution of individual studies to the global results; 4: Sensitivity Analyses for the rate of catheter colonization

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Additional file 7. The incidence of catheter colonization

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Additional file 4. Publication bias assessment

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Additional file 2. Random sequence generation of the included trials

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Additional file 10. The catheter colonization rate estimates from a multiple treatment meta-analysis compared with the direct and indirect estimates, which were based on back-calculated, and pair-wise meta-analyses. Direct and indirect estimates of effect and the corresponding Bayesian “I2” for inconsistency were calculated. And the “I2” from pooled pair-wise meta-analysis for heterogeneity were also calculated

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Additional file 5. Model fit for the CRBSIs per 1000 catheter-days rate results

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Additional file 3. Heterogeneity analysis by random model

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Additional file 9. The ORs and 95% CrIs: the conventional standard catheter versus chlorhexidine/silver sulfadiazine and antibiotic catheters