title: Sedation guidelines, protocols, and algorithms in PICUs: a systematic review.
abstract: OBJECTIVE
  To evaluate the impact of sedation guidelines, protocols, and algorithms on clinical outcomes in PICUs.
  
  
  METHODS
  CINAHL, Medline, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews,
  
  
  METHODS
  : English-only publications from 1966 to December 2013, which included keywords "sedation," "guideline," "algorithm," "protocol," and "pediatric intensive care." We included all primary studies involving critically ill children on sedation guidelines, protocols, and algorithms and excluded those which focused mainly on diagnostic or procedural purposes.
  
  
  METHODS
  Two authors independently screened each article for inclusion. A standardized data extraction sheet was used to extract data from all included studies.
  
  
  RESULTS
  Among the 1,283 citations yielded from our search strategy, six observational studies were included in the final review. Due to the heterogeneity of the studies included, clinical outcomes were not combined into a meta-analysis. A descriptive account of the studies was formulated to characterize all included studies. The three outcomes of interest were clinical outcomes, patients' comfort and safety, and sedative use. We found an association between the use of sedation guidelines, protocols, and algorithms and reduced PICU length of stay, frequency of unplanned extubation, prevalence of patients experiencing drug withdrawal, total sedation duration, and doses. Overall, the quality of identified studies is low.
  
  
  CONCLUSIONS
  Despite widespread recommendation for the use of sedation guidelines, protocols, and algorithms in critically ill children, our systematic review revealed a paucity of high-quality evidence to guide this practice. More robust studies are urgently needed for this important aspect of PICU care.
authors.affiliation: 1Division of Nursing, Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore. 2Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children Hospital, Singapore. 3Office of Clinical Sciences, Duke-NUS Graduate School of Medicine, Singapore.
authors.forename: Ya Nee
authors.initials: YN
authors.lastname: Poh
authors.forename: Pei Fen
authors.initials: PF
authors.lastname: Poh
authors.forename: Siti Nur Hanim
authors.initials: SN
authors.lastname: Buang
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000465:Algorithms; D002985:Clinical Protocols; D016638:Critical Illness / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D010043:Outcome and Process Assessment, Health Care; D012121:Respiration, Artificial
chemical_list: D006993:Hypnotics and Sedatives