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. Author manuscript; available in PMC: 2019 Apr 17.
Published in final edited form as: Mayo Clin Proc. 2015 Apr 9;90(5):613–623. doi: 10.1016/j.mayocp.2015.02.016

TABLE.

Characteristics of Included Randomized Controlled Trials Comparing Protocoled Sedation vs Usual Care Without Protocoled Sedation on Clinical Outcomes in Mechanically Ventilated Adult ICU Patientsa

Reference,
year, location		 Sample
size		 ICU type
(setup)		 Age (y).
mean
 Male sex
(%)
 APACHE
II score,
Mean
 Most cases Drugs used Sedation scale
(Weaning
protocol)		 Intervention Control Follow-up Reported
outcomesb
I C I C I C
Brook et al,7
 1999
Single center
United States		 321 Medical
 (closed)		 57.8 58.1 51.2 47.2 23.1 23.2 Pneumonia Diazepam,
 fentanyl,
 lorazepam,
 midazolam,
 morphine,
 haloperidol		 Ramsay
 (Yes)		 Nurse-
 implemented
 continuous
 sedation
 algorithm
 (n=162)		 Physician-directed
 continuous
 sedation (n= 159)		 Hospital
 dischargec 		1, 3–7
Kress et al,8
 2000
Single center
United States		 128 Medical
 (closed)c 		57d 6ld 50 43.3 20d 22d COPD or
  ventilatory
 failure		 Midazolam,
 morphine,
 propofol		 Ramsay
 (Yesc)		 Daily interruption
 of sedation until
  patients were
  awake (n=68)		 ICU physician—
 directed
 sedative
 interruption
 (n=60)		 Hospital
 discharge		 1, 3–8
Bucknall et al,12
  2008
Single center Australia		 312 General
 (closed)		 58.2 56.1 64 58 18.6 19.5 Medical Diazepam,
 haloperidol,
 fentanyl,
 midazolam,
 morphine,
 propofol		 SAS
 (No)		 Nurse-
 implemented
 sedation
 algorithm
 (n=159)		 Sedation
 medication type
 and dose limits
 for infusion and
 boluses
 prescribed by
 ICU medical staff
 (n=153)		 Hospital
 dischargee 		0, 1, 3–6, 8
Girard et al,11
 2008
Multicenter
United States		 335 Medical
 (mixed)c 		60d 64d 54 51 26d 26.5d Sepsis/ARDS Benzodiazepines,f
 haloperidol,
 opiates,f
 propofol		 RASS
 (Yes)		 Nurse-
 implemented
 daily interruption
 of sedation plus a
 daily spontaneous
 breathing trial
 (n=167)		 Sedation per usual
 care plus a daily
 spontaneous
 breathing trial
 (n=168)		 1 y 2, 3c, 4, 5g, 6–8
Anifantaki
 et al,10 2009
Single center Greece		 97 Medical;
 surgical
 (closed)c 		52.1 56.1 71.4 72.9 17.4 18.9 Trauma Fentanyl,
 midazolam,
 morphine,
 propofol,
 remifentanil		 Ramsay
 (NR)		 Nurse-
 implemented
 daily interruption
 of sedation
 (n=49)		 ICU medical
 staff—
 directed
 sedation
 (n=48)		 Hospital
 discharge		 1, 3–5
Weisbrodt
 et al,9 2011
Multicenter
Australia		 50 Medical
 surgical
 trauma
 (closed)c 		65.1 69.1 54 71 23.4 21.4 Respiratory Fetanyl, midazolam,
 propofol		 RASS (No) Daily interruption
 of fentanyl or
 midazolam
 infusions for
 up to 6 h
 (n=26)		 Usual management
 of sedation in
 Australia (n=24)		 6 moc 0, 2–6
a

APACHE II = Acute Physiology and Chronic Health Evaluation II; ARDS = acute respiratory disease syndrome; C = control; COPD = chronic obstructive pulmonary disease; 1 = intervention; ICU = intensive care unit; NR = not reported; RASS = Richmond Agitation Sedation Scale; SAS = Riker Sedation-Agitation Scale.

b

0 = ICU mortality, 1 = hospital mortality 2 = 6- to 12-month mortality, 3 = duration of mechanical ventilation, 4 = ICU length of stay, 5 = hospital length of stay, 6 = incidence of tracheostomy, 7 = incidence of reintubation, 8 = incidence of self-extubation, 9 = incidence of delirium.

c

Reported via email.

d

Values are medians not means.

e

Estimated based on the longest followed mortality measure.

f

Benzodiazepines as lorazepam and opiates as fentanyl equivalents.

g

Median hospital length of stay is reported; however, interquartile range is missing in the control group.