Nurse-Led Sedation in ICU: Impact on Clinical Outcomes of Mechanically Ventilated Patients - A Systematic Review and Meta-Analysis of RCTs.

BACKGROUND

Mechanically ventilated patients in intensive care units (ICUs) often require sedation to tolerate life-sustaining interventions. However, sedation management can be complex, and improper dosing can lead to adverse outcomes. Nurse-led sedation protocols have emerged as a promising strategy to optimize sedation care, but the evidence base remains fragmented.

OBJECTIVE

This systematic review and meta-analysis aim to synthesize the available evidence on the impact of nurse-led sedation protocols on clinical outcomes in mechanically ventilated patients.

METHODS

We conducted a comprehensive search of multiple electronic databases, including PubMed, EMBASE, Scopus, CINAHL, and the Cochrane Library, to identify relevant publications in peer-reviewed journals. To quantify the effects of nurse-led sedation protocols, we calculated the mean difference (MD) and risk ratio (RR) with corresponding 95% confidence intervals. Heterogeneity across studies was evaluated using the Cochrane Q statistic, I2 statistic, and associated p-value. All analyses were performed using RevMan 5.4 software.

RESULTS

This meta-analysis of 16 RCTs, involving 1887 patients, demonstrated the substantial effectiveness of nurse-led sedation protocols in improving clinical outcomes. Specifically, nurse-led sedation protocols significantly reduced: ICU mortality: RR 0.32 (95% CI 0.26-0.38), I2 = 26%, p < .001, incidence of delirium: RR 0.42 (95% CI 0.35-0.49), I2 = 20%, p < .001, length of ICU stay: SMD -3.54 (95% CI -4.20 to -2.88), I2 = 68%, p < .001, length of hospital stay: SMD -1.88 (95% CI -2.31 to -1.45), I2 = 50%, p < .001 and duration of mechanical ventilation: SMD -2.73 (95% CI -3.24 to -2.21), I2 = 65%, p < .001. However, no significant difference was observed in the incidence of self-extubation between nurse-led sedation protocols and usual care: RR 1.09 (95% CI 0.97-1.23), I2 = 0%, p = .15.

CONCLUSION

Implementing nurse-led sedation protocols in ICUs is a safe and effective approach, yielding significant benefits, including reduced mortality rates, shorter ICU and hospital stays, decreased mechanical ventilation duration, and lower incidence of delirium, although they do not impact self-extubation rates.