Comparing different postoperative sedation strategies for patients in the intensive care unit after cardiac surgery: A systematic review of randomized controlled trials and network meta-analysis
Qinxue Hu
Department of Critical Care Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Search for more papers by this authorXing Liu
The Third Central Clinical College, Tianjin Medical University, Tianjin, China
Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Search for more papers by this authorYuancai Xiang
Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
Search for more papers by this authorXianying Lei
Department of Critical Care Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Search for more papers by this authorHong Yu
Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Search for more papers by this authorCorresponding Author
Li Liu
Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Correspondence
Li Liu and Jianguo Feng, Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou 646000, Sichuan Province, China.
Email: [email protected] and [email protected]
Search for more papers by this authorCorresponding Author
Jianguo Feng
Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Correspondence
Li Liu and Jianguo Feng, Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou 646000, Sichuan Province, China.
Email: [email protected] and [email protected]
Search for more papers by this authorQinxue Hu
Department of Critical Care Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Search for more papers by this authorXing Liu
The Third Central Clinical College, Tianjin Medical University, Tianjin, China
Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Search for more papers by this authorYuancai Xiang
Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
Search for more papers by this authorXianying Lei
Department of Critical Care Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Search for more papers by this authorHong Yu
Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Search for more papers by this authorCorresponding Author
Li Liu
Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Correspondence
Li Liu and Jianguo Feng, Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou 646000, Sichuan Province, China.
Email: [email protected] and [email protected]
Search for more papers by this authorCorresponding Author
Jianguo Feng
Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, The Affiliated Hospital, Southwest Medical University, Luzhou, China
Correspondence
Li Liu and Jianguo Feng, Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou 646000, Sichuan Province, China.
Email: [email protected] and [email protected]
Search for more papers by this authorQinxue Hu and Xing Liu contributed equally in this study.
Abstract
Background
Various postoperative sedation protocols with different anaesthetics lead to profound effects on the outcomes for post-cardiac surgery patients. However, a comprehensive analysis of optimal postoperative sedation strategies for patients in the intensive care unit (ICU) after cardiac surgery is lacking.
Methods
We systematically searched for randomized controlled trials (RCTs) in databases including PubMed and Embase. The primary outcome measured the duration of mechanical ventilation (MV) in the ICU, and the secondary outcome encompassed the length of stay (LOS) in the ICU and hospital and the monitoring adverse events.
Results
The literature included 18 RCTs (1652 patients) with 13 sedation regimens. Dexmedetomidine plus ketamine and sevoflurane were associated with a significantly reduced duration of MV when compared with propofol. Our results also suggested that dexmedetomidine plus ketamine may associated with a shorter LOS in ICU, and sevoflurane associated with a shorter LOS in the hospital, respectively.
Conclusions
The combination of dexmedetomidine and ketamine seems to be a better option for adult patients needing sedation after cardiac surgery, and the incidence of side effects is lower with dexmedetomidine. These findings have potential implications for medication management in the perioperative pharmacotherapy of cardiac surgery patients.
CONFLICT OF INTEREST STATEMENT
The authors declare no competing interests.
Open Research
DATA AVAILABILITY STATEMENT
All data generated or analysed during this study are included in this published article and its supplementary information files.
Supporting Information
| Filename | Description |
|---|---|
| bcpt14043-sup-0001-Supplementary Table_1.docxWord 2007 document , 31.7 KB |
Table S1. Supporting Information. |
| bcpt14043-sup-0002-Supplementary Table_2.docxWord 2007 document , 19.9 KB |
Table S2. The quality of evidence of included sedation protocols. |
| bcpt14043-sup-0003-Supplementary Text_1.docxWord 2007 document , 19.5 KB |
Data S1. Supporting Information. |
| bcpt14043-sup-0004-Supplementary Text_2.docxWord 2007 document , 15.8 KB |
Data S2. Supporting Information. |
| bcpt14043-sup-0005-Annotations of supplementary figures.docxWord 2007 document , 13.1 KB |
Figure S1. The details of network meta-analyses of mechanical ventilation. Figure S2. The details of network meta-analyses of length of stay in intensive care unit and hospital. Figure S3. The details of network meta-analyses of total adverse events, delirium, and nausea and vomiting. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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