ICU sedation, delirium & recovery
Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials
Authors' conclusion
When considering procedural sedation and analgesia in the ED and ICU, compared with midazolam-opioids, sedation recovery time is shorter with propofol, patient satisfaction is better with ketamine-propofol, and respiratory adverse events are less common with ketamine.
Study context
- Population
- Adults and children >30 days of age requiring emergent procedures with procedural sedation and analgesia (PSA) in the emergency department (ED) or ICU
- Participants
- 8,105 adults · 82 RCTs
- Comparison
- i.v. PSA agents vs midazolam-opioids
Methodological detailsfrequentist random-effects model, Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) certainty rating
- Frequentist random-effects model
- GRADE certainty rating
Further pooled results
| Outcome | Mean difference (min) (95% CI) | |
|---|---|---|
| Sedation recovery timePropofol vs Midazolam-opioids · fewer minutes; high certainty | 16.3 (8.4–24.3) | |
| −100102030Difference, min (linear scale) |
| Outcome | Mean difference (points) (95% CI) | |
|---|---|---|
| Patient satisfactionKetamine-propofol vs Midazolam-opioids · better; high certainty | 1.5 (0.3–2.6) | |
| −2024Difference, points (linear scale) |
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| Respiratory AEsKetamine vs Midazolam-opioids · high certainty | 0.55 (0.32–0.96) | |
| Gastrointestinal AEsKetamine-midazolam vs Midazolam-opioids · high certainty | 3.08 (1.15–8.27) | |
| Neurological AEsKetamine-propofol vs Midazolam-opioids · high certainty | 3.68 (1.08–12.53) | |
| 0.050.21520Relative risk (log scale) |
Original publication
Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials. Br J Anaesth. Published 6 January 2024. doi:10.
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