{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T20:53:44Z","timestamp":1765832024053,"version":"3.48.0"},"reference-count":27,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T00:00:00Z","timestamp":1644192000000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,1,18]]},"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The COVID-19 pandemic has renewed interest in the use of inhaled anaesthetics for sedation of ventilated critically ill patients. Preliminary data show that inhaled anaesthetics reduce lung inflammation, time to extubation and intensive care unit length of stay compared with intravenous sedatives. However, the impact of inhaled anaesthetics on cognitive and psychiatric outcomes is not well described in this setting. Randomised controlled trials are underway to establish if inhaled anaesthetics affect these and other patient and health system outcomes. Our aim is to summarise the known effects of inhaled sedatives on cognitive and psychiatric outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>In this systematic review, we will use MEDLINE, EMBASE, and PsycINFO to identify studies from 1970 to 2021 that assessed cognitive and psychiatric outcomes in critically ill adult patients sedated with inhaled anaesthetics. We will include case series, observational and cohort studies and randomised controlled trials. We will exclude case studies due to the heterogeneity of reporting in these studies. For randomised controlled trials comparing inhaled to intravenous sedation, we will report cognitive and psychiatric outcomes for both study arms. Studies will be selected based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data will be extracted using a standardised data extraction tool by two independent reviewers. Studies will be assessed for bias using the Cochrane risk of bias tool for randomised controlled trials, or the Newcastle-Ottawa Scale for cohort and case\u2013control studies. Findings will be reported according to outcome and descriptive statistics will be used to illustrate findings in a narrative fashion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The systematic review uses published data and therefore does not require ethics approval. Results will be disseminated via publication in peer-reviewed journals and presentation at conferences related to the field.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42021236455.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-052893","type":"journal-article","created":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T11:45:48Z","timestamp":1644234348000},"page":"e052893","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Effect of sedation with inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults: a systematic review protocol"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct04415060","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04415060","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2594-6121","authenticated-orcid":false,"given":"Sean","family":"Cuninghame","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Western Ontario, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8480-6516","authenticated-orcid":false,"given":"Kevin","family":"Gorsky","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Conall","family":"Francoeur","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Laval University, Quebec, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davinia","family":"Withington","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, McGill University Faculty of Medicine, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Burry","sequence":"additional","affiliation":[{"name":"Departments of Pharmacy and Medicine, Sinai Health System, Toronto, Ontario, Canada"},{"name":"Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Jerath","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Temetry Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Sunnybrook Research Institute, Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Mangement and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marat","family":"Slessarev","sequence":"additional","affiliation":[{"name":"Department of Medicine, Western University, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,2,7]]},"reference":[{"key":"2025121512481260000_12.2.e052893.1","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1007\/s12630-020-01713-5","article-title":"Therapeutic alternatives and strategies for drug conservation in the intensive care unit during times of drug shortage: a report of the Ontario COVID-19 ICU drug Task force","volume":"67","author":"Kanji","year":"2020","journal-title":"Can J Anaesth"},{"key":"2025121512481260000_12.2.e052893.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-019-05877-7"},{"key":"2025121512481260000_12.2.e052893.3","first-page":"e0256","article-title":"Volatile isoflurane in critically ill coronavirus disease 2019 Patients-A case series and systematic review","volume":"2","author":"Flinspach","year":"2020","journal-title":"Crit Care Explor"},{"key":"2025121512481260000_12.2.e052893.4","doi-asserted-by":"crossref","first-page":"e40","DOI":"10.1213\/ANE.0000000000004887","article-title":"Sedation of mechanically ventilated COVID-19 patients: challenges and special considerations","volume":"131","author":"Hanidziar","year":"2020","journal-title":"Anesth Analg"},{"key":"2025121512481260000_12.2.e052893.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-011-2187-3"},{"key":"2025121512481260000_12.2.e052893.6","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1164\/rccm.201604-0686OC","article-title":"Sevoflurane for sedation in acute respiratory distress syndrome. A randomized controlled pilot study","volume":"195","author":"Jabaudon","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"2025121512481260000_12.2.e052893.7","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1213\/ANE.0000000000001634","article-title":"Safety and efficacy of volatile anesthetic agents compared with standard intravenous Midazolam\/Propofol sedation in ventilated critical care patients: a meta-analysis and systematic review of prospective trials","volume":"124","author":"Jerath","year":"2017","journal-title":"Anesth Analg"},{"key":"2025121512481260000_12.2.e052893.8","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jcrc.2020.04.012","article-title":"Critical care capacity during the COVID-19 pandemic: global availability of intensive care beds","volume":"58","author":"Ma","year":"2020","journal-title":"J Crit Care"},{"key":"2025121512481260000_12.2.e052893.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.08.015"},{"key":"2025121512481260000_12.2.e052893.10","doi-asserted-by":"crossref","DOI":"10.3390\/scipharm89010006","article-title":"Sedating mechanically ventilated COVID-19 patients with volatile anesthetics: insights on the Last-Minute potential weapons","volume":"89","author":"Suleiman","year":"2021","journal-title":"Sci Pharm"},{"key":"2025121512481260000_12.2.e052893.11","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201904-0816CI"},{"key":"2025121512481260000_12.2.e052893.12","first-page":"160","article-title":"Icu delirium \u2015 a diagnostic and therapeutic challenge in the intensive care unit","volume":"50","author":"Kotfis","year":"2018","journal-title":"Anestezjol Intens Ter"},{"key":"2025121512481260000_12.2.e052893.13","first-page":"1","article-title":"Delirium","volume":"6","author":"Wilson","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"2025121512481260000_12.2.e052893.14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1301372"},{"key":"2025121512481260000_12.2.e052893.15","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-59121-0"},{"key":"2025121512481260000_12.2.e052893.16","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.mayocp.2017.11.005","article-title":"Potentially modifiable risk factors for long-term cognitive impairment after critical illness: a systematic review","volume":"93","author":"Sakusic","year":"2018","journal-title":"Mayo Clin Proc"},{"key":"2025121512481260000_12.2.e052893.17","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/S2213-2600(18)30062-6","article-title":"Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort study","volume":"6","author":"Girard","year":"2018","journal-title":"Lancet Respir Med"},{"key":"2025121512481260000_12.2.e052893.18","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1097\/CCM.0000000000004573","article-title":"Effect of Nonsedation on cognitive function in survivors of critical illness","volume":"48","author":"Nedergaard","year":"2020","journal-title":"Crit Care Med"},{"key":"2025121512481260000_12.2.e052893.19","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000001811"},{"key":"2025121512481260000_12.2.e052893.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2016.08.005"},{"key":"2025121512481260000_12.2.e052893.21","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1186\/s13054-019-2489-3","article-title":"Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis","volume":"23","author":"Righy","year":"2019","journal-title":"Crit Care"},{"key":"2025121512481260000_12.2.e052893.22","doi-asserted-by":"publisher","DOI":"10.1186\/cc11677"},{"key":"2025121512481260000_12.2.e052893.23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j2708"},{"key":"2025121512481260000_12.2.e052893.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.intell.2006.02.001"},{"key":"2025121512481260000_12.2.e052893.25","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181c17da8"},{"key":"2025121512481260000_12.2.e052893.26","doi-asserted-by":"publisher","DOI":"10.1177\/0963721410389459"},{"key":"2025121512481260000_12.2.e052893.27","doi-asserted-by":"crossref","unstructured":"Rethlefsen ML , Kirtey S , Waffenschmidt S , et al . PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews 2021;10:1\u201319.","DOI":"10.5195\/jmla.2021.962"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-052893","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T20:48:25Z","timestamp":1765831705000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-052893"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,7]]},"published-print":{"date-parts":[[2022,2]]}},"alternative-id":["10.1136\/bmjopen-2021-052893"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-052893","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2022,2]]}}}