Introduction: Sedation type and depth are modifiable factors in the care of mechanically ventilated patients and may significantly influence clinical outcomes. This umbrella review synthesizes current evidence comparing the effects of sedation agents including benzodiazepines, propofol, and dexmedetomidine as well as sedation depth (light vs. deep) on duration of mechanical ventilation, ICU length of stay, mortality, and reintubation rates.
Methods: A comprehensive synthesis of recent systematic reviews, meta-analyses, and clinical guidelines was done. Outcomes of interest included days on mechanical ventilation, ICU length of stay, mortality, and reintubation rates.
Results: Non-benzodiazepine sedation (propofol or dexmedetomidine) was associated with shorter mechanical ventilation duration (mean difference [MD] −1.9 days) and ICU stay (MD −1.62 days) compared to benzodiazepines, without a significant difference in mortality. Dexmedetomidine, compared to midazolam, further reduced ICU stay (MD −2.25 days), ventilation duration (MD −0.83 days), and risk of delirium, though mortality remained unchanged. Light sedation was consistently associated with improved outcomes, including lower mortality (odds ratio 0.34), reduced ventilation duration (MD −2.1 days), and shorter ICU stay (MD −3.0 days). Reintubation rates showed no consistent differences across sedation strategies. Current guidelines from the Society of Critical Care Medicine recommend light sedation in mechanically ventilated adults to enhance recovery and reduce complications.
Conclusions: Sedation strategies favoring non-benzodiazepine agents and targeting light sedation are associated with improved clinical outcomes, including reduced duration of mechanical ventilation and ICU stay, and lower mortality. These findings support guideline-based practices and emphasizes the importance of individualized, evidence-informed sedation management in the ICU.
