ICU挥发性镇静系统回顾和荟萃分析
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Volatile sedation in the intensive care unit：A systematic review and meta-analysis
背景与目的
与静脉（IV）镇静相比，重症监护室（ICU）中的挥发性镇静可减少不良事件的发生次数并改善患者预后。我们进行了系统回顾和荟萃分析，比较ICU成人患者中挥发性和静脉镇静的影响。
方 法
我们搜索了PubMed，Embase，Cochrane中心登记和Web of Science数据库的所有随机对照实验，用于比较使用麻醉保存装置（ACD）的挥发性镇静与IV镇静在苏醒及拔管时间，ICU入住时间和总住院时间以及药物的终末器官效应。
结 果
纳入了共计1027名患者的13项试验。 通过ACD给药的挥发性镇静（七氟醚或异氟醚）对比IV镇静，缩短了唤醒时间[平均差（MD），80.0分钟; 95％可信区间（95％可信区间），134.5至25.6; P = .004]和拔管时间（MD，196.0分钟; 95％
可信区间，305.2至86.8; P <.001） （咪达唑仑或丙泊酚）。两组之间的ICU和住院时间没有差异。 从5项研究中镇静的心脏效应分析显示，使用挥发性镇静的患者ICU入院后6小时的血清肌钙蛋白水平低于静脉镇静患者（P <0.05）。 入住ICU后12〜24小时肌钙蛋白的效应值最大（MD，0.27mg / L; 95％CIs，0.44〜0.09; P = 0.003）。
结 论
与IV镇静相比，ICU通过ACD给予挥发性镇静剂管理缩短了唤醒和拔管时间。 考虑到双臂血清肌钙蛋白水平的差异，挥发性麻醉药可能有一个即使在浅麻醉剂量下心脏手术后的心肌保护作用。 由于纳入的研究使用的样本量较小且异质性较高，需要进一步进行大规模，高质量的前瞻性临床试验来证实我们的发现。
原始文献摘要
Ha Yeon Kim, MDa, Ja Eun Lee, MDa, Ha Yan Kim,, et al. Volatile sedation in the intensive care unit A systematic review and meta-analysis.[J]. Kim et al. Medicine (2017) 96:49
Abstract：
Background: Volatile sedation in the intensive care unit (ICU) may reduce the number of adverse events and improve patient outcomes compared with intravenous (IV) sedation. We performed a systematic review and meta-analysis comparing the effects of volatile and IV sedation in adult ICU patients.
Methods:We searched the PubMed, Embase, Cochrane Central Register, and Web of Science databases for all randomized trials comparing volatile sedation using an anesthetic-conserving device (ACD) with IV sedation in terms of awakening and extubation times, lengths of ICU and hospital stay, and pharmacologic end-organ effects.
Results: Thirteen trials with a total of 1027 patients were included. Volatile sedation (sevoflurane or isoflurane) administered through an ACD shortened the awakening time [mean difference (MD),80.0 minutes; 95% confidence intervals (95% CIs),134.5 to25.6;P=.004] and extubation time (MD, 196.0 minutes; 95% CIs, 305.2 to 86.8; P<.001) compared with IV sedation (midazolam or propofol). No differences in the lengths of ICU and hospital stay were noted between the 2 groups. In the analysis of cardiac effects of sedation from 5 studies, patients who received volatile sedation showed lower serum troponin levels 6hours after ICU admission than patients who received IV sedation (P<.05). The effect size of troponin was largest between 12 and 24hours after ICU admission (MD,0.27mg/L; 95% CIs, 0.44 to 0.09; P=.003).
Conclusion: Compared with IV sedation, volatile sedation administered through an ACD in the ICU shortened the awakening and extubation times. Considering the difference in serum troponin levels between both arms, volatile anesthetics might have a myocardial protective effect after cardiac surgery even at a subanesthetic dose. Because the included studies used small sample sizes with high heterogeneity, further large, high-quality prospective clinical trials are needed to confirm our findings.
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