Effects of nurse-led sedation protocols on mechanically ventilated intensive care adults: A systematic review and meta-analysis

Abstract

Objectives: The objective of the study was to compare nurse-led sedation protocols with physician-led usual care in intensive care units (ICUs) in treating mechanically ventilated adult patients.

Review method used: This is a systematic review and meta-analysis.

Data sources: PubMed, Cochrane Library, EMBASE, CINAHL, China National Knowledge Infrastructure, and China Wanfang databases were interrogated for articles published before May 2020.

Review method: As per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, eight randomised controlled trials (RCTs) and six preintervention and postintervention studies published in English and Chinese met the inclusion criteria for the meta-analysis. Two reviewers independently extracted data into a tabular format using predefined data fields. Disagreements were resolved by consensus. The quality of the included RCTs and preintervention and postintervention studies was assessed using the Cochrane Quality Assessment Tool and Risk Of Bias In Non-randomised Studies of Interventions assessment tool.

Results: Eight RCTs were of intermediate methodological quality, and six preintervention and postintervention studies exhibited a low to moderate risk of bias. Compared with usual care, nurse-led sedation protocols resulted in significantly decreased durations of mechanical ventilation (days) (standardised mean difference = -1.765; 95% confidence interval [CI] = -2.461, -1.068); P < 0.001; I² = 97.7%); decreased length of ICU stay (days) (standardised mean difference = -1.463; 95% CI = -2.181, -0.745; P < 0.001; I² = 97.3%); reduced ICU mortality (relative risk [RR] = 0.854; 95% CI = 0.747, 0.983; P = 0.027), I² = 0%); and decreased incidence of ventilator-associated pneumonia (RR = 0.438; 95% CI = 0.292, 0.657; P < 0.001; I² = 41.4%), delirium (RR = 0.522; 95% CI = 0.338, 0.807; P = 0.003; I² = 26.6%), and extubation failure (RR = 0.498; 95% CI = 0.266, 0.932; P = 0.029; I² = 45.1%).

Conclusions: Although pre-post intervention study design cannot establish causality, the present findings raise the considerable possibility that a sedation protocol can be safely implemented by nurses to reduce mortality in ICUs and sedation-related adverse events in patients on mechanical ventilation compared with physician-led usual care.

Keywords: ICU; Mechanical ventilation; Meta-analysis; Nurse-led; Protocol; Review; Sedation.