Daily sedation interruption versus routine sedation in critically ill children: A systematic review and meta-analysis

Background: Strategies aiming lighter sedation have demonstrated promising results in adults. This review was designed to evaluate the efficacy and safety of daily sedation interruption (DSI) versus sedation protocols in mechanically ventilated children. Methods: This was a systematic review and meta-analysis. We searched MEDLINE, Scopus, Cochrane Library and Web of Science from 1980 to August 2018 for randomized control trials comparing the two forms of sedation in question, with outcomes that included duration of mechanical ventilation, length of stay in the pediatric intensive care unit, total midazolam doses and adverse events. Results: Three studies were included in the review and meta-analysis after fulfilling the inclusion criteria. One was a multicenter trial and two were single-center trials, with a total of 261 patients. There was a shorter duration of both mechanical ventilation and intensive care stay, but with marked heterogeneity. All the results were in favor of DSI except adverse events which were higher in the DSI group. Conclusion: On comparison of DSI to routine sedation, we found evidence of benefit as regards, duration of mechanical ventilation, length of intensive care unit stay and midazolam doses. However, there was some evidence of harm with more adverse events.