ИСТИНА

Background and Goal of Study: Sedation is frequently used in in- tensive care units (ICUs) to prevent arouse and delirium associated harm, relieve anxiety, and reduce the stress of being mechanically ventilated. Since agitation and anxiety occurs in about 30%-80% of patients being treated in the ICU settings, sedation is a highly sought strategy for ICU patients. The aim of this study was to comprehensively assess published randomized and non-randomized peer-reviewed studies which compared volatile (VA) and intravenous (I/V) anesthetics for ICU se- dation, with the hypothesis that the type of sedation may have an impact on mortality and other clinically relevant outcomes. Materials and Methods: Studies comparing VA versus I/V anes- thetics used in the ICU settings were independently systematically searched in PubMed, Medline, Google Scholar, Russian Science Citation Index and Cochrane databases. 15 studies (1520 patients of predominantly surgical profile needed VA sedation for less than 96 h) were included. Results and Discussion: VA had no impact on all-cause mortal- ity (very low quality of evidence, Odds Ratio=0.82 [0.60-1.12], p = 0.20). VA were associated with a reduction in duration of mechanical ventilation (very low quality of evidence, Odds Ratio=−0.46 [−0.88 to −0.04)], p = 0.03), increase in ventilator-free days (very low qual- ity of evidence, Odds Ratio=0.46 [0.28-0.64], p < 0.001). VA also reduced postoperative level of cardiac troponin (low quality of evi- dence, Odds Ratio=−0.52 [−0.84 to −0.20], p = 0.001), time to ex- tubation (moderate quality of evidence, Odds Ratio= −1.59 [−2.26 to −0.91]; p <0.001) and awakening (very low quality of evidence, Odds Ratio=−1.30 [−2.54 to −0.06]; p = 0.04). No dif ferences were observed in length of ICU stay (moderate quality of evidence, p=0.93), length of hospital stay (low quality of evidence, p=0.69), and need for catecholamines (very low quality of evidence, p = 0.5). Conclusion(s): Volatile sedation vs propofol causes the increase in ventilator-free days acompined with reduction of time to ex tubation and the drop of troponin release in both medical or surgical ICU patients. The shortening of awakening was proofed only for surgical ICU patients.