title: Sedation protocols to reduce duration of mechanical ventilation in the ICU: a Cochrane Systematic Review.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cochrane systematic review of randomized controlled trials.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: NHMRC, Centre for Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Queensland, Australia.|Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia.|School of Health Sciences, City University London, UK.
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Aitken
authors.affiliation: Centre for Quality and Patient Safety, School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia.|Director of Nursing Research Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Tracey
authors.initials: T
authors.lastname: Bucknall
authors.affiliation: School of Nursing and Midwifery, Plymouth University, UK.
authors.forename: Bridie
authors.initials: B
authors.lastname: Kent
authors.affiliation: NHMRC, Centre for Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Queensland, Australia.|Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia.
authors.forename: Marion
authors.initials: M
authors.lastname: Mitchell
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Queensland, Australia.|Princess Alexandra Hospital, Queensland, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Burmeister
authors.affiliation: NHMRC, Centre for Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Keogh
mesh_terms: D000758:Anesthesia / Q000592:standards*; D003422:Critical Care / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000592:standards*; D013997:Time Factors
keywords: critical care; evidence-based practice; sedation; systematic reviews and meta-analyses