title: Effect of Protocolized Sedation on Clinical Outcomes in Mechanically Ventilated Intensive Care Unit Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  To assess the effects of protocolized sedation (algorithm or daily interruption) compared with usual care without protocolized sedation on clinical outcomes in mechanically ventilated adult intensive care unit (ICU) patients via a systematic review and meta-analysis of randomized controlled trials (RCTs).
  
  
  METHODS
  We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov from their inception to February 28, 2013. A random-effects model was used to synthesize risk ratios (RRs) and weighted mean differences (WMDs).
  
  
  RESULTS
  Of 4782 records screened, 6 RCTs including 1243 patients met the inclusion criteria. Protocolized sedation was associated with significant reductions in overall mortality (RR, 0.85; 95% CI, 0.74 to 0.97; P=.02; number needed to treat, 20; P=.11), ICU length of stay (WMD, -1.73 days; 95% CI, -3.32 to -0.14 days; P=.03), hospital length of stay (WMD, -3.55 days; 95% CI, -5.98 to -1.12 days; P=.004), and tracheostomy (RR, 0.69; 95% CI, 0.50 to 0.96; P=.03; number needed to treat, 16.6; P=.04; 5 RCTs) compared with usual care. Protocolized sedation produced no significant differences in duration of mechanical ventilation (WMD, -1.04 days; 95% CI, -2.54 to 0.47 days; P=.18), reintubation (RR, 0.78; 95% CI, 0.52 to 1.15; P=.21; 3 RCTs), and self-extubation (RR, 1.49; 95% CI, 0.46 to 4.82; P=.51; 4 RCTs) compared with usual care. Included studies did not report delirium incidence.
  
  
  CONCLUSIONS
  In mechanically ventilated adults in closed, nonspecialty ICUs, protocolized sedation seems to decrease overall mortality (15%), ICU and hospital lengths of stay (1.73 and 3.55 days, respectively), and tracheostomy (31%) compared with usual care without protocolized sedation.
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH. Electronic address: mahadminhas@gmail.com.
authors: Mahad A
authors: MA
authors: Minhas
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH; Department of Critical Care, Newport Hospital, Newport, RI; Department of Medicine-Section of Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Adrian G
authors: AG
authors: Velasquez
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH; Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA.
authors: Anubhav
authors: A
authors: Kaul
authors: Department of Medicine-Section of Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Pedro D
authors: PD
authors: Salinas
authors: Division of Pulmonary-Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors: Leo A
authors: LA
authors: Celi
mesh_terms: D000465:Algorithms; D002985:Clinical Protocols; D016292:Procedural Sedation; D003422:Critical Care; D054810:Deep Sedation; D006801:Humans; D007362:Intensive Care Units; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial