A systematic review of interventions to facilitate extubation in patients difficult-to-wean due to delirium, agitation, or anxiety and a meta-analysis ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-01-23

AUTHORS

Sébastien Dupuis, Dave Brindamour, Stephanie Karzon, Anne Julie Frenette, Emmanuel Charbonney, Marc M. Perreault, Patrick Bellemare, Lisa Burry, David R. Williamson

ABSTRACT

BackgroundDelirium, agitation, and anxiety may hinder weaning from mechanical ventilation and lead to increased morbidity and healthcare costs. The most appropriate clinical approach to weaning in these contexts remains unclear and challenging to clinicians. The objective of this systematic review was to identify effective and safe interventions to wean patients that are difficult-to-wean from mechanical ventilation due to delirium, agitation, or anxiety.MethodsA systematic review was performed using MEDLINE, EMBASE, and PubMed. Studies evaluating mechanically ventilated patients deemed difficult-to-wean due to delirium, agitation, or anxiety, and comparing the effects of an intervention with a comparator arm were sought. Time-to-extubation was the primary outcome while the secondary outcome was intensive care unit (ICU) length of stay.ResultsFrom 10,860 studies identified, eight met the inclusion criteria: six studies assessed dexmedetomidine while the remaining two assessed loxapine and biofeedback. Pooled analysis of studies assessing dexmedetomidine showed reduced time-to-extubation (six studies, n = 303) by 10.9 hr compared with controls (95% confidence interval [CI], -15.7 to -6.1; I2 = 68%) and ICU length of stay (four studies, n = 191) by 2.6 days (95% CI, 1.9 to 3.3; I2 = 0%). Nevertheless, the evidence was deemed to be of low quality given the small sample sizes and high heterogeneity. Studies assessing other interventions did not identify improvements compared with controls. Safety assessment was globally poorly reported.ConclusionsThis systematic review and meta-analysis provides low quality evidence to suggest the use of dexmedetomidine in patients deemed difficult-to-wean due to agitation, delirium, or anxiety. Insufficient evidence was found regarding other interventions to provide any recommendation.Trial registrationPROSPERO (CRD42016042528); registered 15 July, 2016. More... »

PAGES

318-327

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s12630-018-01289-1

DOI

http://dx.doi.org/10.1007/s12630-018-01289-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1111630656

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30674004


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26 schema:description BackgroundDelirium, agitation, and anxiety may hinder weaning from mechanical ventilation and lead to increased morbidity and healthcare costs. The most appropriate clinical approach to weaning in these contexts remains unclear and challenging to clinicians. The objective of this systematic review was to identify effective and safe interventions to wean patients that are difficult-to-wean from mechanical ventilation due to delirium, agitation, or anxiety.MethodsA systematic review was performed using MEDLINE, EMBASE, and PubMed. Studies evaluating mechanically ventilated patients deemed difficult-to-wean due to delirium, agitation, or anxiety, and comparing the effects of an intervention with a comparator arm were sought. Time-to-extubation was the primary outcome while the secondary outcome was intensive care unit (ICU) length of stay.ResultsFrom 10,860 studies identified, eight met the inclusion criteria: six studies assessed dexmedetomidine while the remaining two assessed loxapine and biofeedback. Pooled analysis of studies assessing dexmedetomidine showed reduced time-to-extubation (six studies, n = 303) by 10.9 hr compared with controls (95% confidence interval [CI], -15.7 to -6.1; I2 = 68%) and ICU length of stay (four studies, n = 191) by 2.6 days (95% CI, 1.9 to 3.3; I2 = 0%). Nevertheless, the evidence was deemed to be of low quality given the small sample sizes and high heterogeneity. Studies assessing other interventions did not identify improvements compared with controls. Safety assessment was globally poorly reported.ConclusionsThis systematic review and meta-analysis provides low quality evidence to suggest the use of dexmedetomidine in patients deemed difficult-to-wean due to agitation, delirium, or anxiety. Insufficient evidence was found regarding other interventions to provide any recommendation.Trial registrationPROSPERO (CRD42016042528); registered 15 July, 2016.
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32 schema:keywords BackgroundDelirium
33 ConclusionsThis systematic review
34 EMBASE
35 ICU length
36 MEDLINE
37 MethodsA systematic review
38 PubMed
39 ResultsFrom
40 Secondary outcomes
41 agitation
42 analysis
43 anxiety
44 approach
45 appropriate clinical approach
46 arm
47 assessment
48 biofeedback
49 clinical approach
50 clinicians
51 comparator arm
52 context
53 control
54 cost
55 criteria
56 days
57 delirium
58 dexmedetomidine
59 effect
60 effect of dexmedetomidine
61 evidence
62 extubation
63 healthcare costs
64 heterogeneity
65 high heterogeneity
66 hr
67 improvement
68 inclusion criteria
69 insufficient evidence
70 intensive care unit length
71 intervention
72 lead
73 length
74 low quality
75 low-quality evidence
76 loxapine
77 mechanical ventilation
78 morbidity
79 objective
80 outcomes
81 patients
82 pooled analysis
83 primary outcome
84 quality
85 quality evidence
86 recommendations
87 review
88 safe intervention
89 safety assessment
90 sample size
91 size
92 small sample size
93 stay
94 study
95 systematic review
96 time
97 trials
98 unit length
99 use
100 use of dexmedetomidine
101 ventilation
102 wean
103 wean patients
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