Nursing-implemented Sedation Protocol on Outcomes of Sedation and Mechanical Ventilation: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 GEXiang-yu ¹ ,  HUYan ¹ , XUJian-ming ² , QINWei ² , ZHUXiao-ling ²

1. School of Nursing, Fudan University, Shanghai 200032, China;
2. Zhongshan Hospital of Fudan University, Shanghai 200032, China;

Corresponding?author：

HUYan, Email: huyan@fudan.edu.cn

Keywords：

Sedation protocol/protocol-directed sedation; Nurse; Mechanical ventilation; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.20150074

Video：

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Objective To systematically review the effects of nursing-implemented sedation protocol on outcomes of mechanical ventilation and sedation in mechanically ventilated ICU patients. Methods We searched EMbase (Ovid), The Joanna Briggs Institute EBP Database (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL, Ovid), MEDLINE (Ovid), Web of Knowledge, CINAHL, CBM, CNKI, WanFang Data and VIP to collect studies on nursing-implemented sedation protocol up to January 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 11 studies involving 2118 patients (1 037 were in the intervention group, and 1 081 were in the control group) were included. The results of meta-analysis showed that nursing-implemented sedation protocol could reduce the total dosage of midazolam (MD=-163.82, 95%CI -309.81 to -17.84, P=0.03), the daily dosage of midazolam (MD=-37.22, 95%CI -61.14 to -13.29, P<0.01), and the incidence rate of VAP (RR=0.53, 95%CI 0.34 to 0.81, P<0.01). However, nursing-implemented sedation protocol had no effects on the length of mechanical ventilation, the length of ICU stay, and self-extubation. Conclusion Compared with the usual sedation management, nursing-implemented sedation protocol can reduce the dosage of midazolam and the incidence rate of VAP. But no statistical significances are found in the length of mechanical ventilation, the length of ICU and the incidence rate of self-extubation.

Citation： GEXiang-yu, HUYan, XUJian-ming, QINWei, ZHUXiao-ling. Nursing-implemented Sedation Protocol on Outcomes of Sedation and Mechanical Ventilation: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2015, 15(4): 445-451. doi: 10.7507/1672-2531.20150074 Copy

1.	Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial):a randomised controlled trial. Lancet, 2008, 371(9607):126-134.
2.	Finkielman JD. Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med, 2010, 38(1):349-350.
3.	Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 2013, 41(1):263-306.
4.	中華醫學會重癥醫學分會. 中國重癥加強治療病房患者鎮痛和鎮靜治療指導意見(2006). 中華外科雜志, 2006, 44(17):1158-1166.
5.	Higgins JPT, Altman DG, Sterne JAC, et al. Chapter 8:Assessing risk of bias in included studies. In:Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Available at:http://www.cochrane.org/handbook.
6.	Guillermo B, Eduardo T, Auirre M. The implementation of an analgesia-based sedation protocol reduced deep sedatin and proved to be safe and feasible in patients on menchanical ventilation. Rev Bras Ter Intensiva, 2013, 23(3):188-196.
7.	Yiliaz C, Kelebek G, Ozdemir N, et al. The effect of nursing-implemented sedation on the duration of mechanical ventilation in the ICU. Turk J of Tram & Em Surg, 2010, 6(16):521-527.
8.	Muller L, Chanques G, Bourgaux C, et al. Impact of the use of propofol remifentanil goal-directed sedation adapted by nurses on the time to extubation in mechanically ventilated ICU patients:the experience of a French ICU. Ann Fr Anesth Reanim, 2008, 27(6):481-489.
9.	de Wit M, Gennings C, Jenvey WI, et al. Randomized trial comparing daily interruption of sedation and nursing-implemented sedation algorithm in medical intensive care unit patients. Crit Care, 2008, 12(3):70-78.
10.	Bucknall TK, Manias E, Presneill JJ. A randomized trial of pyotocol-directed sedation management for mechanical ventilation in an Australian intensive care unit. Crit Care Med, 2008, 36(5):1444-1450.
11.	Quenot JP, Ladoire S, Devoucoux F, et al. Effect of a nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia. Crit Care Med, 2007, 35(9):2031-2036.
12.	Elliott R, Mckinley S, Aitken LM, et al. The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit. Intens Care Med, 2006, 32(10):1506-1514.
13.	de Jonghe B, Bastuji-Garin S, Fangio P, et al. Sedation algorithm in critically ill patients without acute brain injury. Crit Care Med, 2005, 33(1):120-127.
14.	Brattebo G, Hofoss D, Flaatten H, et al. Quality improvement report-Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit. Brit Med J, 2002, 324(7350):1386-1389.
15.	Brook AD, Ahrens TS, Schaiff R, et al. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med, 1999, 27(12):2609-2615.
16.	陶然, 陳利群, 吳俊梅, 等. 標準化鎮靜護理給藥方案的制訂及在ICU患者鎮靜治療中的應用. 護理學雜志, 2013, 28(9):1-4.
17.	William DS, John PK. Strategies to optimize analgesia and sedation. Crit Care, 2008, 12(Suppl 3):S6.
18.	Curtis N, Sessler SP. Protocolized and target based sedation and analgesia in the ICU. Crit Care Clin, 2009, 25(3):489-513.

1. Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial):a randomised controlled trial. Lancet, 2008, 371(9607):126-134.
2. Finkielman JD. Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med, 2010, 38(1):349-350.
3. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 2013, 41(1):263-306.
4. 中華醫學會重癥醫學分會. 中國重癥加強治療病房患者鎮痛和鎮靜治療指導意見(2006). 中華外科雜志, 2006, 44(17):1158-1166.
5. Higgins JPT, Altman DG, Sterne JAC, et al. Chapter 8:Assessing risk of bias in included studies. In:Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Available at:http://www.cochrane.org/handbook.
6. Guillermo B, Eduardo T, Auirre M. The implementation of an analgesia-based sedation protocol reduced deep sedatin and proved to be safe and feasible in patients on menchanical ventilation. Rev Bras Ter Intensiva, 2013, 23(3):188-196.
7. Yiliaz C, Kelebek G, Ozdemir N, et al. The effect of nursing-implemented sedation on the duration of mechanical ventilation in the ICU. Turk J of Tram & Em Surg, 2010, 6(16):521-527.
8. Muller L, Chanques G, Bourgaux C, et al. Impact of the use of propofol remifentanil goal-directed sedation adapted by nurses on the time to extubation in mechanically ventilated ICU patients:the experience of a French ICU. Ann Fr Anesth Reanim, 2008, 27(6):481-489.
9. de Wit M, Gennings C, Jenvey WI, et al. Randomized trial comparing daily interruption of sedation and nursing-implemented sedation algorithm in medical intensive care unit patients. Crit Care, 2008, 12(3):70-78.
10. Bucknall TK, Manias E, Presneill JJ. A randomized trial of pyotocol-directed sedation management for mechanical ventilation in an Australian intensive care unit. Crit Care Med, 2008, 36(5):1444-1450.
11. Quenot JP, Ladoire S, Devoucoux F, et al. Effect of a nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia. Crit Care Med, 2007, 35(9):2031-2036.
12. Elliott R, Mckinley S, Aitken LM, et al. The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit. Intens Care Med, 2006, 32(10):1506-1514.
13. de Jonghe B, Bastuji-Garin S, Fangio P, et al. Sedation algorithm in critically ill patients without acute brain injury. Crit Care Med, 2005, 33(1):120-127.
14. Brattebo G, Hofoss D, Flaatten H, et al. Quality improvement report-Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit. Brit Med J, 2002, 324(7350):1386-1389.
15. Brook AD, Ahrens TS, Schaiff R, et al. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med, 1999, 27(12):2609-2615.
16. 陶然, 陳利群, 吳俊梅, 等. 標準化鎮靜護理給藥方案的制訂及在ICU患者鎮靜治療中的應用. 護理學雜志, 2013, 28(9):1-4.
17. William DS, John PK. Strategies to optimize analgesia and sedation. Crit Care, 2008, 12(Suppl 3):S6.
18. Curtis N, Sessler SP. Protocolized and target based sedation and analgesia in the ICU. Crit Care Clin, 2009, 25(3):489-513.

Chinese Journal of Evidence-Based Medicine

Nursing-implemented Sedation Protocol on Outcomes of Sedation and Mechanical Ventilation: A Systematic Review

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