Background
Methods
The literature search
Inclusion criteria
Data extraction
Risk of bias assessment
Statistical analysis
Results
Trial identification
Study characteristics
Study | Study location | Study date | Population | Procedure | Control medication | Total number of patients | Mean age (years) | Male (%) | Delirium assessment | Endpoint delirium | |
---|---|---|---|---|---|---|---|---|---|---|---|
Sedation comparison | Chang [52] | Taiwan | 2014–2015 | Non-cardiac surgery | Postoperatively for a maximum of 24 h, RASS-2-0 | Propofol | 60 | 70.5 | 58.3 | CAM-ICU | 2 |
Lee [55] | South Korea | 2016–2017 | Non-cardiac surgery | Intraoperatively as continuous infusion or bolus | Placebo | 318 | 73 | 44.3 | CAM | 1 | |
Mei [54] | China | 2016–2017 | Non-cardiac surgery | Intraoperatively as bolus and subsequent continuous infusion | Propofol | 296 | 75 | 45.6 | CAM | 1 | |
Sheikh [53] | India | 2014–2016 | Cardiac surgery | Intraoperatively as bolus and subsequent continuous infusion | Propofol | 60 | 34.6 | N/A | * | 2 | |
Skrobik [56] | USA | 2013–2016 | MV** | 9:30 in the evening until 6:15 the next morning, continuous infusion without bolus, RASS-1 | Placebo | 100 | 62.3 | 64 | ICDSC | 1 | |
Deiner [33] | USA | 2008–2014 | Non-cardiac surgery | Entering OR until 2 h in recovery room | Placebo | 390 | 74*** | 48.7 | CAM CAM-ICU | 1 | |
Kawazoe [44] | Japan | 2013–2016 | MV | Continuously until end of MV, RASS-0 by day, RASS-2 by night | Propofol midazolam | 201 | 68.5 | 63.2 | CAM | 2 | |
Li [45] | China | 2014–2015 | Cardiac surgery | Intraoperatively and continuously until end of MV | Placebo | 285 | 67 | 69.1 | CAM CAM-ICU | 1 | |
Li [43] | China | 2015–2016 | MV | Sedation for at least 48 h until end of MV, RASS-0–1 in intervention, RASS − 2/− 3 in control group | Propofol, midazolam | 126 | 44 | 56.3 | CAM-ICU | 1 | |
Djaiani [46] | Canada | 2011–2014 | Cardiac surgery | Postoperatively and continuously until end of MV | Propofol | 183 | 72.6 | 75.4 | CAM CAM-ICU | 1 | |
Liu [47] | China | 2015 | Cardiac surgery | Postoperatively on ICU admission and continuously until end of MV, RASS-3-0 | Propofol | 61 | 54*** | 41 | CAM | 2 | |
Liu [49] | China | 2014–2016 | Non-cardiac surgery | Intraoperatively until 20 min before end of surgery | Placebo | 197 | 73 | 48.7 | CAM | 1 | |
Su [58] | China | 2011–2013 | Non-cardiac surgery | Postoperatively until 8:00 the next morning | Placebo | 700 | 74.4 | 60.4 | CAM | 1 | |
MacLaren [50] | USA | 2009–2012 | MV | Continuously until end of MV, according to desired SAS | Midazolam | 23 | 58.1 | 56.5 | ICDSC | 2 | |
Priye [51] | India | 2012–2013 | Cardiac surgery | Postoperatively for 12 h | Placebo | 64 | 43.3 | 51.6 | RASS | 2 | |
Yang [34] | China | 2013 | Non-cardiac surgery | Intraoperatively until 1 h before end of surgery and postoperatively until 6:00 the next morning | Placebo | 79 | 50.5 | 53.2 | CAM-ICU | 2 | |
Devlin [35] | USA | 2008–2012 | NIV | 2 h stable after NIV mask removal, SAS 3–4 | Placebo | 33 | 65 | 51.5 | ICDSC | 2 | |
Park [36] | South Korea | 2012–2013 | Cardiac surgery | Postoperatively until end of MV, RSS 2–3 | Remifentanil | 142 | 52.7 | 55.6 | CAM-ICU | 1 | |
Huang [37] | China | 2008–2011 | NIV | Until end of sedation, RSS 2–3 | Midazolam | 62 | 64.5 | 41.9 | N/A | 2 | |
Jakob [38] | Europe + Russia | 2007–2010 | MV | Continuously until end of MV, RASS-3-0 | Propofol, midazolam | 998 | 65*** | 65.5 | CAM-ICU | 2 | |
Maldonado [39] | USA | N/A | Cardiac surgery | Postoperatively until end of MV | Propofol, midazolam | 118 | 57.7 | 63.6 | CAM CAM-ICU | 1 | |
Ruokonen [40] | Switzerland + Finland | N/A | MV | Continuously until end of MV, according to desired RASS | Propofol, midazolam | 85 | 66*** | 82.4 | CAM-ICU | 2 | |
Shehabi [41] | Australia | 2004–2007 | Cardiac surgery | Postoperatively until ICU discharge, MAAS 2–4 | Morphine | 299 | 71.3*** | 75.3 | CAM-ICU | 1 | |
Pandharipande [32] | USA | 2004–2006 | MV | Continuously until end of MV, according to desired RASS | Lorazepam | 103 | 59.5*** | 51.5 | CAM-ICU | 1 | |
Corbett [42] | USA | 2002–2004 | Cardiac surgery | Postoperatively until end of MV, RSS 5 the first 2 h, RSS 3–4 afterward | Propofol | 89 | 63 | 82 | N/A | 3 | |
Treatment comparison | Reade [57] | Australia + New Zealand | 2011–2013 | AD (MV) | According to desired RASS = 0 | Placebo | 74 | 57.3*** | 75.7 | CAM-ICU | 3 |
Yapici 2010 | Turkey | 2005–2007 | AD (cardiac surgery) | According to blood pressure and heart rate | Midazolam | 72 | 60 | 37.5 | CAM-ICU | 3 | |
Reade [59] | Australia | 2006–2008 | AD (MV) | According to desired RASS = 0 | Haloperidol | 20 | 60.3*** | 85 | ICDSC | 3 |
Quality of evidence
Incidence comparison
Subgroup and sensitivity analyses | Number of data sets | Number of patients | Risk ratio (95% CI) random effect model |
I
2
|
---|---|---|---|---|
Placebo
| ||||
Overall | 10 | 2071 | 0.52 (0.42–0.63) | 37% |
Studies with no risk of bias according to our risk of bias assessment | 5 | 887 | 0.66 (0.43–1.03) | 20% |
Cardiac surgery | 2 | 349 | 0.53 (0.22–1.24) | 1% |
Mechanical ventilation | 0 | |||
Non-cardiac surgery | 6 | 1589 | 0.53 (0.35–0.80) | 61% |
Standard sedatives
| ||||
Overall | 15 | 2463 | 0.63 (0.46–0.86) | 69% |
Studies with no risk of bias according to our risk of bias assessment | 2 | 998a* | 0.64 (0.41–0.98) | 0% |
Cardiac surgery | 5 | 509 | 0.40 (0.23–0.69) | 11% |
Mechanical ventilation | 7 | 1536 | 0.82 (0.60–1.11) | 66% |
Non-cardiac surgeryb | 2 | 356 | 0.46 (0.23–0.90) | NA |
Trim-and-fill method | 20c | – | 0.77 (0.57–1.05) | 64% |
Opioids
| ||||
Overall | 2 | 441 | 0.61 (0.44–0.83) | 0% |