Evaluating sedation strategies in acute respiratory distress syndrome: A meta-analysis of inhaled versus intravenous agents.

Summary

This PROSPERO-registered PRISMA meta-analysis (7 studies; n=1349) found that volatile inhaled sedation reduced ICU stay and duration of mechanical ventilation versus intravenous agents, without a mortality difference. Inhaled sedation was associated with fewer ventilator-free days and changes in gas exchange (higher PaCO2, lower pH), indicating potential trade-offs.

Key Findings

• Included 7 studies (n=1349) comparing inhaled vs IV sedation in ARDS under PRISMA with PROSPERO registration.
• Inhaled sedation reduced ICU length of stay (MD -2.07 days; 95% CI -3.72 to -0.41; p=0.01).
• Inhaled sedation reduced duration of mechanical ventilation (MD -2.62 days; 95% CI -4.48 to -0.76; p=0.006).
• Inhaled sedation was associated with fewer ventilator-free days (MD -1.82; 95% CI -3.41 to -0.24; p=0.02).
• No difference in mortality (p=0.18); inhaled agents improved PEEP on day 1 but increased PaCO2 and reduced arterial pH.

Clinical Implications

Volatile inhaled sedation may shorten ICU stay and ventilation duration, but clinicians should monitor for hypercapnia and acidosis and consider the observed reduction in ventilator-free days. Protocolized selection and monitoring could optimize benefits while mitigating risks.

Limitations

• Heterogeneity and inclusion of both randomized and observational studies
• Potential confounding from sedation delivery devices and clinical protocols; limited mortality data

Future Directions

Large, multicenter RCTs comparing standardized inhaled vs intravenous sedation protocols in ARDS with patient-centered outcomes (VFDs, mortality, delirium) and physiologic monitoring.