{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:38:25Z","timestamp":1791412705067,"version":"4.3.3"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T00:00:00Z","timestamp":1713916800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T00:00:00Z","timestamp":1713916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Med Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Amidst the routine utilization of protocolized sedation in ventilated ICU patients, existing management guidelines exhibit a lack of unanimous recommendations for its widespread adoption. This study endeavors to comprehensively assess the effectiveness and safety of protocolized sedation in critically ill ventilated patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>The primary objective of this study was to systematically review and conduct a meta-analysis of clinical trials comparing protocolized sedation with standard management in critically ill ventilated patients. Key outcomes under scrutiny include ICU and hospital mortality, ventilation days, duration of ICU stay, and incidents of self-extubation. The evaluation incorporates the Risk of Bias 2 (RoB2) tool to assess the quality of included studies. Data analysis utilizes a random-effects model for relative risk (RR) and mean differences. Subgroup analysis categorizes sedation protocols into algorithmic or daily interruption, addressing potential heterogeneity. Additionally, a GRADE evaluation is performed to ascertain the overall certainty of the evidence.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>From an initial pool of 1504 records, 10 studies met the inclusion criteria. Protocolized sedation demonstrated a reduced RR for mortality (RR: 0.80, 95% CI 0.68\u20130.93, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090%) and a decrease in ventilation days (mean difference: \u2212\u20091.12, 95% CI \u2212\u20092.11 to \u2212\u20090.14, <jats:italic>p<\/jats:italic>\u2009=\u20090.03, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200984%). Furthermore, there was a notable reduction in ICU stay (mean difference: \u2212\u20092.24, 95% CI \u2212\u20093.59 to \u2212\u20090.89, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200981%). However, incidents of self-extubation did not exhibit a significant difference (RR: 1.20, 95% CI 0.49\u20132.94, <jats:italic>p<\/jats:italic>\u2009=\u20090.69, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200935%). Subgroup analyses effectively eliminated heterogeneity (<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090%), and the GRADE evaluation yielded moderate results for mortality, ventilation days, and ICU duration.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Protocolized sedation, whether implemented algorithmically or through daily interruption, emerges as a safe and effective approach when compared to standard management in ventilated ICU patients. The findings from this study contribute valuable insights to inform evidence-based practices in sedation management for this critical patient population.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40001-024-01839-y","type":"journal-article","created":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T16:03:02Z","timestamp":1713974582000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Optimizing patient outcomes: a comprehensive evaluation of protocolized sedation in intensive care settings: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0190-9959","authenticated-orcid":false,"given":"Fredy Leonardo Carre\u00f1o","family":"Hernandez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Valentina Stozitzky","family":"R\u00edos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yenny Rocio Cardenas","family":"Bolivar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4320-3150","authenticated-orcid":false,"given":"Jorge Iv\u00e1n Alvarado","family":"S\u00e1nchez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,24]]},"reference":[{"key":"1839_CR1","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1007\/s40140-021-00446-5","volume":"11","author":"V Page","year":"2021","unstructured":"Page V, McKenzie C. Sedation in the intensive care unit. Curr Anesthesiol Rep. 2021;11:92\u2013100. https:\/\/doi.org\/10.1007\/s40140-021-00446-5.","journal-title":"Curr Anesthesiol Rep"},{"issue":"9713","key":"1839_CR2","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/S0140-6736(09)62072-9","volume":"375","author":"T Str\u00f8m","year":"2010","unstructured":"Str\u00f8m T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomized trial. Lancet. 2010;375(9713):475\u201380.","journal-title":"Lancet"},{"issue":"9","key":"1839_CR3","doi-asserted-by":"publisher","first-page":"E825","DOI":"10.1097\/CCM.0000000000003299","volume":"46","author":"JW Devlin","year":"2018","unstructured":"Devlin JW, Skrobik Y, G\u00e9linas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation\/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):E825\u201373.","journal-title":"Crit Care Med"},{"issue":"5","key":"1839_CR4","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/j.mayocp.2015.02.016","volume":"90","author":"MA Minhas","year":"2015","unstructured":"Minhas MA, Velasquez AG, Kaul A, Salinas PD, Celi LA. Effect of protocolized sedation on clinical outcomes in mechanically ventilated intensive care unit patients: a systematic review and meta-analysis of randomized controlled trials. Mayo Clin Proc. 2015;90(5):613\u201323.","journal-title":"Mayo Clin Proc"},{"key":"1839_CR5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021. https:\/\/doi.org\/10.1136\/bmj.n71.","journal-title":"BMJ"},{"key":"1839_CR6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","volume":"366","author":"JAC Sterne","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomized trials. BMJ. 2019;366: l4898.","journal-title":"BMJ"},{"issue":"9","key":"1839_CR7","doi-asserted-by":"publisher","first-page":"2520","DOI":"10.1177\/0962280219889080?journalCode=smma","volume":"29","author":"S McGrath","year":"2020","unstructured":"McGrath S, Zhao XF, Steele R, Thombs BD, Benedetti A, Levis B, et al. Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis. Stat Methods Med Res. 2020;29(9):2520\u201337. https:\/\/doi.org\/10.1177\/0962280219889080?journalCode=smma.","journal-title":"Stat Methods Med Res"},{"key":"1839_CR8","unstructured":"Deeks JJ, Higgins JPT, editors. 9.5.2 Identifying and measuring heterogeneity. Chapter 9 Sect Anal data Undert meta-analyses 952 Higgins JPT, Green S (editors) Cochrane Interv Handb Syst Rev Cochrane, version 502 (updated Sept 2009) Collab 2009. 2009;(i):100. https:\/\/handbook-5-1.cochrane.org\/chapter_9\/9_5_2_identifying_and_measuring_heterogeneity.htm. Accessed 31 Aug 2022."},{"key":"1839_CR9","unstructured":"Higgins J, Green S. 12.2.1 The GRADE approach. In: Cochrane handbook for systematic reviews of interventions version 5.1.0. 2011. https:\/\/handbook-5-1.cochrane.org\/chapter_12\/12_2_1_the_grade_approach.htm. Accessed 31 Aug 2022."},{"issue":"4","key":"1839_CR10","doi-asserted-by":"publisher","first-page":"199","DOI":"10.15171\/jcs.2019.028","volume":"8","author":"Z Taran","year":"2019","unstructured":"Taran Z, Namadian M, Faghihzadeh S, Naghibi T. The effect of sedation protocol using richmond agitation sedation scale (RASS) on some clinical outcomes of mechanically ventilated patients in intensive care units: a randomized clinical trial. J Caring Sci. 2019;8(4):199\u2013206.","journal-title":"J Caring Sci"},{"issue":"12","key":"1839_CR11","doi-asserted-by":"publisher","first-page":"2609","DOI":"10.1097\/00003246-199912000-00001","volume":"27","author":"AD Brook","year":"1999","unstructured":"Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, et al. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med. 1999;27(12):2609\u201315.","journal-title":"Crit Care Med"},{"issue":"19","key":"1839_CR12","doi-asserted-by":"publisher","first-page":"1985","DOI":"10.1001\/jama.2012.13872","volume":"308","author":"S Mehta","year":"2012","unstructured":"Mehta S, Burry L, Cook D, Fergusson D, Steinberg M, Granton J, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA. 2012;308(19):1985\u201392.","journal-title":"JAMA"},{"issue":"5","key":"1839_CR13","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1111\/j.1365-2648.2009.04967.x","volume":"65","author":"S Anifantaki","year":"2009","unstructured":"Anifantaki S, Prinianakis G, Vitsaksaki E, Katsouli V, Mari S, Symianakis A, et al. Daily interruption of sedative infusions in an adult medical-surgical intensive care unit: randomized controlled trial. J Adv Nurs. 2009;65(5):1054\u201360.","journal-title":"J Adv Nurs"},{"issue":"5","key":"1839_CR14","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1097\/CCM.0b013e318168f82d","volume":"36","author":"TK Bucknall","year":"2008","unstructured":"Bucknall TK, Manias E, Presneill JJ. A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit. Crit Care Med. 2008;36(5):1444\u201350.","journal-title":"Crit Care Med"},{"key":"1839_CR15","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.jcrc.2019.06.008","volume":"53","author":"M Tanios","year":"2019","unstructured":"Tanios M, Nguyen HM, Park H, Mehta S, Epstein SK, Youssef F, et al. Analgesia-first sedation in critically ill adults: a US pilot, randomized controlled trial. J Crit Care. 2019;53:107\u201313.","journal-title":"J Crit Care"},{"issue":"8","key":"1839_CR16","doi-asserted-by":"publisher","first-page":"1983","DOI":"10.1097\/CCM.0b013e31828a437d","volume":"41","author":"Y Shehabi","year":"2013","unstructured":"Shehabi Y, Bellomo R, Reade MC, Bailey M, Bass F, Howe B, et al. Early goal-directed sedation versus standard sedation in mechanically ventilated critically III patients: a pilot study. Crit Care Med. 2013;41(8):1983\u201391.","journal-title":"Crit Care Med"},{"issue":"20","key":"1839_CR17","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1056\/nejm200005183422002","volume":"342","author":"JP Kress","year":"2000","unstructured":"Kress JP, Pohlman AS, O\u2019Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342(20):1471\u20137. https:\/\/doi.org\/10.1056\/nejm200005183422002.","journal-title":"N Engl J Med"},{"issue":"9607","key":"1839_CR18","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1016\/S0140-6736(08)60105-1","volume":"371","author":"TD Girard","year":"2008","unstructured":"Girard TD, Kress JP, Fuchs BD, Thomason JWW, Schweickert WD, Pun BT, 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 randomized controlled trial. Lancet. 2008;371(9607):126\u201334.","journal-title":"Lancet"},{"issue":"6","key":"1839_CR19","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1016\/j.jcrc.2013.06.019","volume":"28","author":"P Mansouri","year":"2013","unstructured":"Mansouri P, Javadpour S, Zand F, Ghodsbin F, Sabetian G, Masjedi M, et al. Implementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: a randomized clinical trial. J Crit Care. 2013;28(6):918\u201322.","journal-title":"J Crit Care"}],"container-title":["European Journal of Medical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40001-024-01839-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40001-024-01839-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40001-024-01839-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T16:09:10Z","timestamp":1713974950000},"score":1,"resource":{"primary":{"URL":"https:\/\/eurjmedres.biomedcentral.com\/articles\/10.1186\/s40001-024-01839-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,24]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["1839"],"URL":"https:\/\/doi.org\/10.1186\/s40001-024-01839-y","relation":{},"ISSN":["2047-783X"],"issn-type":[{"value":"2047-783X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,24]]},"assertion":[{"value":"4 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 April 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 April 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Does not apply.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Does not apply.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The author(s) declare that they do not have competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"255"}}