Level of sedation in critically ill adult patients: a protocol for a systematic review with meta-analysis and trial sequential analysis

Ameldina Ceric, Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden.
Johan Holgersson, Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden.
Teresa May, Department of Critical Care, Maine Medical Center, Portland, Maine, USA.Follow
Markus B. Skrifvars, Department of Emergency Care and Services, Helsinki University, Helsinki University Hospital, Helsinki, Finland.
Johanna Hästbacka, Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Manoj Saxena, Senior Lecturer, Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Anders Aneman, Intensive Care Unit, South Western Sydney Local Health District, Liverpool Hospital, South Western Sydney Local Health District, South Western Sydney Clinical School, University of New South Wales, and Faculty of Medicine, Health and Human Sciences, Macquarie University, Liverpool, New South Wales, Australia.
Anthony Delaney, The George Institute for Global Health and the University of New South Wales, Sydney, New South Wales, Australia.
Michael C. Reade, Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Denmark, Denmark.
Candice Delcourt, Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
Janus Jakobsen, Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Denmark, Denmark.
Niklas Nielsen, Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden.

Document Type

Article

Publication Date

9-8-2022

Institution/Department

Critical Care Medicine

Journal Title

BMJ open

MeSH Headings

Adult; Humans; Critical Care; Critical Illness; Hypnotics and Sedatives; Intensive Care Units; Length of Stay; Meta-Analysis as Topic; Systematic Reviews as Topic; Randomized Controlled Trials as Topic

Abstract

INTRODUCTION: It is standard of care to provide sedation to critically ill patients to reduce anxiety, discomfort and promote tolerance of mechanical ventilation. Given that sedatives can have differing effects based on a variety of patient and pharmacological characteristics, treatment approaches are largely based on targeting the level of sedation. The benefits of differing levels of sedation must be balanced against potential adverse effects including haemodynamic instability, causing delirium, delaying awakening and prolonging the time of mechanical ventilation and intensive care stay. This systematic review with meta-analysis aims to investigate the current evidence and compare the effects of differing sedation levels in adult critically ill patients. METHODS AND ANALYSES: We will conduct a systematic review based on searches of preidentified major medical databases (eg, MEDLINE, EMBASE, CENTRAL) and clinical trial registries from their inception onwards to identify trials meeting inclusion criteria. We will include randomised clinical trials comparing any degree of sedation with no sedation and lighter sedation with deeper sedation for critically ill patients admitted to the intensive care unit. We will include aggregate data meta-analyses and trial sequential analyses. Risk of bias will be assessed with domains based on the Cochrane risk of bias tool. An eight-step procedure will be used to assess if the thresholds for clinical significance are crossed, and the certainty of the evidence will be assessed using Grades of Recommendations, Assessment, Development and Evaluation. ETHICS AND DISSEMINATION: No formal approval or review of ethics is required as individual patient data will not be included. This systematic review has the potential to highlight (1) whether one should believe sedation to be beneficial, harmful or neither in critically ill adults; (2) the existing knowledge gaps and (3) whether the recommendations from guidelines and daily clinical practice are supported by current evidence. These results will be disseminated through publication in a peer-reviewed journal.

First Page

e061806

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