Comparison of sedation strategies for critically ill patients: A protocol for a systematic review incorporating network meta-analyses

Brian Hutton; Lisa D. Burry; Salmaan Kanji; Sangeeta Mehta; Melanie Guenette; Claudio M. Martin; Dean A. Fergusson; Neill K. Adhikari; Ingrid Egerod; David Williamson; Sharon Straus; David Moher; E. Wesley Ely; Louise Rose

doi:10.1186/s13643-016-0338-x

Comparison of sedation strategies for critically ill patients: A protocol for a systematic review incorporating network meta-analyses

Brian Hutton^*, Lisa D. Burry, Salmaan Kanji, Sangeeta Mehta, Melanie Guenette, Claudio M. Martin, Dean A. Fergusson, Neill K. Adhikari, Ingrid Egerod, David Williamson, Sharon Straus, David Moher, E. Wesley Ely, Louise Rose

^*Corresponding author for this work

Department of Clinical Medicine

6 Citations (Scopus)

103 Downloads (Pure)

Abstract

Background: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug pharmacokinetic limitations and minimize oversedation, thereby shortening the duration of mechanical ventilation. At present, it is unclear which strategy is most effective, as few have been directly compared. Our review will use network meta-analysis (NMA) to compare and rank sedation strategies to determine their efficacy and safety for mechanically ventilated patients. Methods: We will search the following from 1980 to March 2016: Ovid MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science. We will also search the Cochrane Library, gray literature, and the International Clinical Trials Registry Platform. We will use a validated randomized control trial search filter to identify studies evaluating any strategy to optimize sedation in mechanically ventilated adult patients. Authors will independently extract data from eligible studies in duplicate and complete the Cochrane Risk of Bias tool. Our outcomes of interest include duration of mechanical ventilation, time to first extubation, ICU and hospital length of stay, re-intubation, tracheostomy, mortality, total sedative and opioid exposure, health-related quality of life, and adverse events. To inform our NMA, we will first conduct conventional pair-wise meta-analyses using random-effects models. Where appropriate, we will perform Bayesian NMA using WinBUGS software. Discussion: There are multiple strategies to optimize sedation for mechanically ventilated patients. Current ICU guidelines recommend protocolized sedation or daily sedation interruption. Our systematic review incorporating NMA will provide a unified analysis of all sedation strategies to determine the relative efficacy and safety of interventions that may not have been compared directly. We will provide knowledge users, decision makers, and professional societies with ranking of multiple sedation strategies to inform future sedation guidelines. Systematic review registration: PROSPERO CRD42016037480

Original language	English
Article number	157
Journal	Systematic Reviews
Volume	5
Issue number	1
Number of pages	7
ISSN	2046-4053
DOIs	https://doi.org/10.1186/s13643-016-0338-x
Publication status	Published - 2016

Keywords

Daily sedation interruption
Intensive care
Mechanical ventilation
Network meta-analysis
Sedation protocol
Systematic review

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Comparison of sedation strategies for critically ill patients: a protocol for a systematic review incorporating network meta-analysesFinal published version, 638 KBLicence: CC BY

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Hutton, B., Burry, L. D., Kanji, S., Mehta, S., Guenette, M., Martin, C. M., Fergusson, D. A., Adhikari, N. K., Egerod, I., Williamson, D., Straus, S., Moher, D., Ely, E. W., & Rose, L. (2016). Comparison of sedation strategies for critically ill patients: A protocol for a systematic review incorporating network meta-analyses. Systematic Reviews, 5(1), Article 157. https://doi.org/10.1186/s13643-016-0338-x

Hutton, B, Burry, LD, Kanji, S, Mehta, S, Guenette, M, Martin, CM, Fergusson, DA, Adhikari, NK, Egerod, I, Williamson, D, Straus, S, Moher, D, Ely, EW & Rose, L 2016, 'Comparison of sedation strategies for critically ill patients: A protocol for a systematic review incorporating network meta-analyses', Systematic Reviews, vol. 5, no. 1, 157. https://doi.org/10.1186/s13643-016-0338-x

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title = "Comparison of sedation strategies for critically ill patients: A protocol for a systematic review incorporating network meta-analyses",

abstract = "Background: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug pharmacokinetic limitations and minimize oversedation, thereby shortening the duration of mechanical ventilation. At present, it is unclear which strategy is most effective, as few have been directly compared. Our review will use network meta-analysis (NMA) to compare and rank sedation strategies to determine their efficacy and safety for mechanically ventilated patients. Methods: We will search the following from 1980 to March 2016: Ovid MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science. We will also search the Cochrane Library, gray literature, and the International Clinical Trials Registry Platform. We will use a validated randomized control trial search filter to identify studies evaluating any strategy to optimize sedation in mechanically ventilated adult patients. Authors will independently extract data from eligible studies in duplicate and complete the Cochrane Risk of Bias tool. Our outcomes of interest include duration of mechanical ventilation, time to first extubation, ICU and hospital length of stay, re-intubation, tracheostomy, mortality, total sedative and opioid exposure, health-related quality of life, and adverse events. To inform our NMA, we will first conduct conventional pair-wise meta-analyses using random-effects models. Where appropriate, we will perform Bayesian NMA using WinBUGS software. Discussion: There are multiple strategies to optimize sedation for mechanically ventilated patients. Current ICU guidelines recommend protocolized sedation or daily sedation interruption. Our systematic review incorporating NMA will provide a unified analysis of all sedation strategies to determine the relative efficacy and safety of interventions that may not have been compared directly. We will provide knowledge users, decision makers, and professional societies with ranking of multiple sedation strategies to inform future sedation guidelines. Systematic review registration: PROSPERO CRD42016037480",

keywords = "Daily sedation interruption, Intensive care, Mechanical ventilation, Network meta-analysis, Sedation protocol, Systematic review",

author = "Brian Hutton and Burry, {Lisa D.} and Salmaan Kanji and Sangeeta Mehta and Melanie Guenette and Martin, {Claudio M.} and Fergusson, {Dean A.} and Adhikari, {Neill K.} and Ingrid Egerod and David Williamson and Sharon Straus and David Moher and Ely, {E. Wesley} and Louise Rose",

year = "2016",

doi = "10.1186/s13643-016-0338-x",

language = "English",

volume = "5",

journal = "Systematic Reviews",

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T2 - A protocol for a systematic review incorporating network meta-analyses

AU - Hutton, Brian

AU - Burry, Lisa D.

AU - Kanji, Salmaan

AU - Mehta, Sangeeta

AU - Guenette, Melanie

AU - Martin, Claudio M.

AU - Fergusson, Dean A.

AU - Adhikari, Neill K.

AU - Egerod, Ingrid

AU - Williamson, David

AU - Straus, Sharon

AU - Moher, David

AU - Ely, E. Wesley

AU - Rose, Louise

PY - 2016

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N2 - Background: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug pharmacokinetic limitations and minimize oversedation, thereby shortening the duration of mechanical ventilation. At present, it is unclear which strategy is most effective, as few have been directly compared. Our review will use network meta-analysis (NMA) to compare and rank sedation strategies to determine their efficacy and safety for mechanically ventilated patients. Methods: We will search the following from 1980 to March 2016: Ovid MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science. We will also search the Cochrane Library, gray literature, and the International Clinical Trials Registry Platform. We will use a validated randomized control trial search filter to identify studies evaluating any strategy to optimize sedation in mechanically ventilated adult patients. Authors will independently extract data from eligible studies in duplicate and complete the Cochrane Risk of Bias tool. Our outcomes of interest include duration of mechanical ventilation, time to first extubation, ICU and hospital length of stay, re-intubation, tracheostomy, mortality, total sedative and opioid exposure, health-related quality of life, and adverse events. To inform our NMA, we will first conduct conventional pair-wise meta-analyses using random-effects models. Where appropriate, we will perform Bayesian NMA using WinBUGS software. Discussion: There are multiple strategies to optimize sedation for mechanically ventilated patients. Current ICU guidelines recommend protocolized sedation or daily sedation interruption. Our systematic review incorporating NMA will provide a unified analysis of all sedation strategies to determine the relative efficacy and safety of interventions that may not have been compared directly. We will provide knowledge users, decision makers, and professional societies with ranking of multiple sedation strategies to inform future sedation guidelines. Systematic review registration: PROSPERO CRD42016037480

AB - Background: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug pharmacokinetic limitations and minimize oversedation, thereby shortening the duration of mechanical ventilation. At present, it is unclear which strategy is most effective, as few have been directly compared. Our review will use network meta-analysis (NMA) to compare and rank sedation strategies to determine their efficacy and safety for mechanically ventilated patients. Methods: We will search the following from 1980 to March 2016: Ovid MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science. We will also search the Cochrane Library, gray literature, and the International Clinical Trials Registry Platform. We will use a validated randomized control trial search filter to identify studies evaluating any strategy to optimize sedation in mechanically ventilated adult patients. Authors will independently extract data from eligible studies in duplicate and complete the Cochrane Risk of Bias tool. Our outcomes of interest include duration of mechanical ventilation, time to first extubation, ICU and hospital length of stay, re-intubation, tracheostomy, mortality, total sedative and opioid exposure, health-related quality of life, and adverse events. To inform our NMA, we will first conduct conventional pair-wise meta-analyses using random-effects models. Where appropriate, we will perform Bayesian NMA using WinBUGS software. Discussion: There are multiple strategies to optimize sedation for mechanically ventilated patients. Current ICU guidelines recommend protocolized sedation or daily sedation interruption. Our systematic review incorporating NMA will provide a unified analysis of all sedation strategies to determine the relative efficacy and safety of interventions that may not have been compared directly. We will provide knowledge users, decision makers, and professional societies with ranking of multiple sedation strategies to inform future sedation guidelines. Systematic review registration: PROSPERO CRD42016037480

KW - Daily sedation interruption

KW - Intensive care

KW - Mechanical ventilation

KW - Network meta-analysis

KW - Sedation protocol

KW - Systematic review

U2 - 10.1186/s13643-016-0338-x

DO - 10.1186/s13643-016-0338-x

M3 - Journal article

C2 - 27646881

AN - SCOPUS:84988530823

SN - 2046-4053

VL - 5

JO - Systematic Reviews

JF - Systematic Reviews

IS - 1

M1 - 157

ER -

Comparison of sedation strategies for critically ill patients: A protocol for a systematic review incorporating network meta-analyses

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Keywords

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