Cochrane · systematic review · CD009771
Protocol‐directed sedation versus non‐protocol‐directed sedation in mechanically ventilated intensive care adults and children
Aitken, LM, Bucknall, T, Kent, B, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
8
current version
GRADE rated
8
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 6 · 75%Moderate 1 · 12.5%High 1 · 12.5%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyProtocol‐directed sedation management compared with usual care for sedation management in mechanically ventilated intensive care unit patients
Population: mechanically ventilated ICU adults and children requiring sedation management
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of mechanical ventilation (measured in hours for the entire duration of the first ICU stay for each patient) Protocol‐directed sedation management vs usual care | no estimate extracted | 4 studies · 3283 participants | Low Downgraded: risk of bias, inconsistency |
ICU mortality Protocol‐directed sedation management vs usual care | RR 0.77 [0.39, 1.5] | 2 studies · 513 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Hospital mortality Protocol‐directed sedation management vs usual care | RR 0.9 [0.72, 1.13] | 3 studies · 3082 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
ICU length of stay (days) Protocol‐directed sedation management vs usual care | no estimate extracted | 4 studies · 3128 participants | Low Downgraded: risk of bias, inconsistency |
Hospital length of stay (days) Protocol‐directed sedation management vs usual care | no estimate extracted | 3 studies · 2927 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Adverse event ‐ incidence of self‐extubation (in ICU) Protocol‐directed sedation management vs usual care | RR 0.88 [0.55, 1.42] | 2 studies · 2761 participants | High |
Adverse event ‐ incidence of reintubation (in ICU) Protocol‐directed sedation management vs usual care | RR 0.65 [0.35, 1.24] | 1 study · 321 participants | Low Downgraded: risk of bias, imprecision |
Incidence of tracheostomy (in ICU) Protocol‐directed sedation management vs usual care | RR 0.67 [0.35, 1.3] | 3 studies · 3082 participants | Low Downgraded: risk of bias, inconsistency |
Protocol‐directed sedation management compared with usual care for sedation management in mechanically ventilated intensive care unit patients
Population: mechanically ventilated ICU patients requiring sedation management
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Duration of mechanical ventilation (hours) Protocol‐directed sedation management vs usual care | no estimate extracted | 2 studies · 633 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
ICU mortality Protocol‐directed sedation management vs usual care | RR 1.04 [0.67, 1.61] | 1 study · 312 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Hospital mortality Protocol‐directed sedation management vs usual care | RR 0.96 [0.71, 1.31] | 2 studies · 633 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse event ‐ incidence of re‐intubation Protocol‐directed sedation management vs usual care | RR 0.65 [0.35, 1.24] | 1 study · 321 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse event ‐ incidence of self extubation Protocol‐directed sedation management vs usual care | RR 2.08 [0.19, 22.69] | 1 study · 312 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Incidence of tracheostomy Protocol‐directed sedation management vs usual care | RR 0.77 [0.31, 1.89] | 2 studies · 633 participants | Low Downgraded: risk of bias, imprecision, inconsistency |