SynthesisFrontiers in medicine2026
Comparative effectiveness and clinical credibility of nurse-implementable sedation strategies for mechanically ventilated adults in intensive care: a systematic review and network meta-analysis.
Synthesis in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
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.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Sedation in mechanically ventilated adults is managed through bedside workflow strategies - such as nurse-driven protocols and daily sedation interruption - or through sedative drug-choice regimens. These interventions operate at different conceptual levels yet are often synthesised at inconsistent levels of granularity, risking inflated treatment hierarchies and obscured clinical applicability. Methods: We analysed a harmonised dataset of 39 randomised trials (11,946 participants) using frequentist random-effects network meta-analysis. Reporting followed PRISMA 2020 and PRISMA-NMA, risk of bias was assessed with RoB 2, and certainty was graded with CINeMA. The primary outcome was ventilator-free days at day 28 (VFD28). Three prespecified analytical layers were applied: a 17-node intervention network, a merged 5-node strategy network, and a 4-node nurse-only subnetwork. Results: Database and register searching yielded 5,581 records; after removal of 2,056 duplicates, 3,525 titles and abstracts were screened, 113 full reports were assessed, and 39 trials were retained in the final review. In the 17-node network, the numerically top-ranked node was a sparse oversedation-prevention threshold variant (OSP_P0.1), with an estimated mean difference of 4.62 VFD28 days versus usual care, but this estimate was entirely indirect and carried low credibility. The most reproducible gains were observed for daily sedation interruption (2.66 days, 1.49 to 3.83) and protocolised sedation (2.62 days, 1.64 to 3.60) versus usual care. In the merged 5-node strategy network, protocolised sedation remained favourable (2.83 days, 1.55 to 4.12), daily sedation interruption remained favourable (1.84 days, 0.20 to 3.48), and no-sedation favoured usual care (4.51 days, 1.60 to 7.42) but with a thinner evidence base. Restricting the analysis to nurse-implementable strategies preserved the direction of benefit, with protocolised sedation remaining the highest-ranked nursing strategy. Risk of bias was low in one trial, some concerns in 30, and high in eight. CINeMA indicated moderate confidence for protocolised sedation versus usual care and daily sedation interruption versus usual care, but low confidence for sparse or predominantly indirect contrasts. Conclusion: Protocolised sedation and daily sedation interruption emerge as the two nurse-implementable strategies with the strongest combination of effect magnitude, reproducibility, and evidential credibility for improving ventilator-free days. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261303518, CRD420261303518.
Indexed as
Identifiers
What OpenQuestion holds
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.