Evidence map›Paper›PMID 27480314›Full record

Trial reportCritical care (London, England)2016

Variation in diurnal sedation in mechanically ventilated patients who are managed with a sedation protocol alone or a sedation protocol and daily interruption.

Sangeeta Mehta, Maureen Meade, Lisa Burry, Ranjeeta Mallick, Christina Katsios, Dean Fergusson, Peter Dodek, Karen Burns, Margaret Herridge, John W Devlin and 7 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00675363 (A Randomized Trial of Daily Sedative Interruption in Critically Ill, Mechanically Ventilated Patients Being Managed With a Sedation Protocol), which is not on this map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 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.

NCT00675363 nacompletednot on this map

A Randomized Trial of Daily Sedative Interruption in Critically Ill, Mechanically Ventilated Patients Being Managed With a Sedation Protocol

TypeinterventionalSponsorMount Sinai Hospital, CanadaRan2008 to 2012Enrolled410ConditionsCritical IllnessArmsProtocolized Sedation, Protocolized sedation, with daily interruption
3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Sleep and Circadian Rhythm in Critical Illness.Critical care (London, England) · 2019
    Review
  5. Ten tips for ICU sedation.Intensive care medicine · 2018
    Article
  6. "Sedation is tricky": A qualitative content analysis of nurses' perceptions of sedation administration in mechanically ventilated intensive care unit patients.Australian critical care : official journal of the Confederation of Australian Critical Care Nurses · 2018
    Article
  7. 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

17 authors.

Sangeeta MehtaDepartment of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada. Geeta.mehta@utoronto.ca.
Maureen MeadeDepartments of Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Lisa BurryDepartment of Pharmacy and Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
Ranjeeta MallickClinical Epidemiology Program, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Christina KatsiosInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Dean FergussonClinical Epidemiology Program, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Peter DodekDivision of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Karen BurnsInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Margaret HerridgeDepartment of Medicine and Interdepartmental Division of Critical Care Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada.
John W DevlinSchool of Pharmacy, Northeastern University, Boston, Massachusetts, USA.
Maged TaniosDepartment of Medicine, Long Beach Memorial Medical Center, Long Beach, California, USA.
Robert FowlerInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Michael JackaDepartment of Anesthesiology, University of Alberta Hospitals, Edmonton, Alberta, Canada.
Yoanna SkrobikDepartment of Medicine, Hôpital Royal Victoria, Montréal, Quebec, Canada.
Kendiss OlafsonSection of Critical Care, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Deborah CookDepartments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, St Joseph's Healthcare, Hamilton, Ontario, Canada.
SLEAP Investigators and the Canadian Critical Care Trials Group

Funding

CIHR
6 · The paper itself

Abstract

backgroundMechanically ventilated patients may receive more sedation during the night than during the day, potentially delaying extubation. We compared nighttime and daytime benzodiazepine and opioid administration in adult patients enrolled in a multicenter sedation trial comparing protocolized sedation alone or protocolized sedation combined with daily sedation interruption; and we evaluated whether nighttime and daytime doses were associated with liberation from mechanical ventilation.

methodsThis is a secondary analysis of a randomized trial which was conducted in 16 North American medical-surgical ICUs. In all 423 patients, nurses applied a validated sedation scale hourly to titrate benzodiazepine and opioid infusions to achieve a light level of sedation. Using fentanyl equivalents and midazolam equivalents, we compared dosages administered during night (19:00 to 07:00) and day (07:00 to 19:00) shifts. Using multivariable logistic regression we evaluated the association between nighttime and daytime opioid and sedative doses, and spontaneous breathing trial (SBT) conduct, SBT success, and extubation.

resultsNighttime benzodiazepine and opioid doses were significantly higher than daytime doses (mean difference midazolam equivalents 23.3 mg, 95 % CI 12.9, 33.8, p < 0.0001; mean difference fentanyl equivalents 356 mcg, 95 % CI 130, 582, p = 0.0021). Mean Sedation Agitation Scale score was similar between night and day, and was at target (3.2 vs 3.3, 95 % CI -0.05, 0.02, p = 0.35). Self-reported nurse workload was similar during the night and day. Patients were more often restrained during day shifts (76.3 % vs 73.7 %, p < 0.0001), and there were more unintentional device removals during the day compared with night (15.9 % vs 9.1 %, p < 0.0001). Increases in nighttime drug doses were independently associated with failure to meet SBT screening criteria, SBT failure, and the decision not to extubate the patient despite successful SBT.

conclusionPatients received higher doses of opioids and benzodiazepines at night. Higher nighttime doses were associated with SBT failure and delayed extubation.

trial registrationClinicalTrials.gov NCT00675363 . Registered 7 May 2008.

Indexed as

AgedCircadian RhythmClinical ProtocolsDeep SedationFemaleFentanylHumansHypnotics and SedativesIntensive Care UnitsLogistic ModelsMaleMidazolamMiddle AgedMultivariate AnalysisNorth AmericaRespiration, ArtificialFentanylHypnotics and SedativesMidazolamDiurnal rhythmIntensive care unitMechanical ventilationOpioidsProtocolsSedationWeaning

Identifiers

PMID27480314
PMCPMC4968433

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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.