Sedation during mechanical ventilation: a systematic review.

OBJECTIVE A systematic review was performed to determine the most effective agent with which to sedate adult patients who have respiratory failure that requires mechanical ventilation in the medical intensive care unit. DATA SOURCES A computerized literature search of MEDLINE, a U.S. National Library of Medicine online database, from 1966 to August 1998 was conducted. All selected articles were reviewed to identify other relevant articles. STUDY SELECTION Inclusion criteria were as follows: a) population-adults with respiratory failure who received mechanical ventilation in a medical intensive care unit; b) design-prospective, randomized controlled trial; c) intervention-sedation; and d) primary outcome-successful sedation. DATA EXTRACTION Of 71 potentially relevant articles, only 15 randomized trials fulfilled all four selection criteria. DATA SYNTHESIS Clinical heterogeneity among studies precluded statistical pooling of results. CONCLUSIONS More research is needed to determine the most effective agent with which to sedate adult patients who have respiratory failure that requires mechanical ventilation in the medical intensive care unit.