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Sedation protocols to reduce duration of mechanical ventilation in the ICU: a Cochrane Systematic Review
journal contribution
posted on 2016-02-01, 00:00 authored by L M Aitken, Tracey BucknallTracey Bucknall, Bridie KentBridie Kent, M Mitchell, E Burmeister, S KeoghAIMS: Assess the effects of protocol-directed sedation management on the duration of mechanical ventilation and other relevant patient outcomes in mechanically ventilated intensive care unit patients. BACKGROUND: Sedation is a core component of critical care. Sub-optimal sedation management incorporates both under- and over-sedation and has been linked to poorer patient outcomes. DESIGN: Cochrane systematic review of randomized controlled trials. DATA SOURCES: Cochrane Central Register of Controlled trials, MEDLINE, EMBASE, CINAHL, Database of Abstracts of Reviews of Effects, LILACS, Current Controlled Trials and US National Institutes of Health Clinical Research Studies (1990-November 2013) and reference lists of articles were used. REVIEW METHODS: Randomized controlled trials conducted in intensive care units comparing management with and without protocol-directed sedation were included. Two authors screened titles, abstracts and full-text reports. Potential risk of bias was assessed. Clinical, methodological and statistical heterogeneity were examined and the random-effects model used for meta-analysis where appropriate. Mean difference for duration of mechanical ventilation and risk ratio for mortality, with 95% confidence intervals, were calculated. RESULTS: Two eligible studies with 633 participants comparing protocol-directed sedation delivered by nurses vs. usual care were identified. There was no evidence of differences in duration of mechanical ventilation or hospital mortality. There was statistically significant heterogeneity between studies for duration of mechanical ventilation. CONCLUSIONS: There is insufficient evidence to evaluate the effectiveness of protocol-directed sedation as results from the two randomized controlled trials were conflicting.
History
Journal
Journal of advanced nursingVolume
72Issue
2Pagination
261 - 272Publisher
WileyLocation
London, Eng.Publisher DOI
ISSN
1365-2648eISSN
1365-2648Language
engPublication classification
C Journal article; C1 Refereed article in a scholarly journalCopyright notice
2016, WileyUsage metrics
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