Evidence map›Paper›PMID 25865475›Full record

SynthesisMayo Clinic proceedings2015

Effect of Protocolized Sedation on Clinical Outcomes in Mechanically Ventilated Intensive Care Unit Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Mahad A Minhas, Adrian G Velasquez, Anubhav Kaul, Pedro D Salinas, Leo A Celi

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Mayo Clinic proceedings, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
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  6. Observational
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  15. Checklist for managing critical patients' daily awakening.Revista Brasileira de terapia intensiva · 2019
    Article
  16. Observational
  17. Article
  18. Review
  19. ATS Core Curriculum 2016: Part II. Adult Critical Care Medicine.Annals of the American Thoracic Society · 2016
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Mahad A MinhasThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH. Electronic address: mahadminhas@gmail.com.
Adrian G VelasquezThe 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.
Anubhav KaulThe 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.
Pedro D SalinasDepartment of Medicine-Section of Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Leo A CeliDivision of Pulmonary-Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA.

Funding

Critical Care Informatics: Ethical considerations around the use and sharing of health-related dataR01EB017205 · NIBIB · MASSACHUSETTS INSTITUTE OF TECHNOLOGY · PI CELI, LEO ANTHONY G, MARK, ROGER GREENWOOD · 2014 to 2021
$3.8M
NIBIB NIH HHS R01 EB017205NIBIB NIH HHS R01 EB017205-01A1
6 · The paper itself

Abstract

objectiveTo 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).

methodsWe 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).

resultsOf 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.

conclusionIn 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.

Indexed as

Deep SedationProcedural SedationRespiration, ArtificialAlgorithmsClinical ProtocolsCritical CareHumansIntensive Care UnitsRandomized Controlled Trials as Topic

Identifiers

PMID25865475
PMCPMC6469349

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.