Table 2.
Evidence profiles
| Certainty assessment | No. of patients | Effect | Certainty | Importance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Fentanyl | Other Opioids |
Relative (95% CI) |
Absolute (95% CI) |
||
| Mortality | ||||||||||||
| 2 | Randomized trials | Not serious | Not serious | Not serious | Very serious a | None | 4/72 (5.6%) | 8/119 (6.7%) |
RR 0.79 (0.24 to 2.60) |
14 fewer per 1000 (from 51 fewer to 108 more) |
⨁⨁◯◯ LOW |
CRITICAL |
| Duration of mechanical ventilation | ||||||||||||
| 7 | Randomized trials | Not serious | Serious b | Not serious | Not serious | None | 251 | 283 | - |
MD 0.49 higher (0.9 lower to 1.88 higher) |
⨁⨁⨁◯ MODERATE |
CRITICAL |
| Duration of the ICU stay | ||||||||||||
| 7 | Randomized trials | Not serious | Serious c | Not serious | Not serious | None | 251 | 283 | - |
MD 7.04 higher (3.27 lower to 17.35 higher) |
⨁⨁⨁◯ MODERATE |
CRITICAL |
| Severe adverse events | ||||||||||||
| 4 | Randomized trials | Not serious | Not serious | Not serious | Very serious a | None | 13/173 (7.5%) | 15/255 (5.9%) |
RR 0.98 (0.50 to 1.90) |
1 fewer per 1000 (from 29 fewer to 53 more) |
⨁⨁◯◯ LOW |
CRITICAL |
| Delirium | ||||||||||||
| 3 | Randomized trials | Serious d | Not serious | Not serious | Serious e | None | 30/106 (28.3%) | 23/103 (22.3%) |
RR 1.27 (0.79 to 2.04) |
60 more per 1000 (from 47 fewer to 232 more) |
⨁⨁◯◯ LOW |
CRITICAL |
CI Confidence interval, RR Risk ratio, MD Mean difference, ICU Intensive care unit
a The assessment was downgraded by two levels because it did not meet the optimal information size and the 95% CI spanned 0.75 to 1.25, which was the threshold for judgment
b The grade was downgraded by one level because I2 for heterogeneity was 93%
c The grade was downgraded by one level because I2 for heterogeneity was 93%
d Muellejans et al. (28.9% weight of all results) used different sedatives in the intervention and control groups, and Spies et al.’s study (29.2% weight of all results) was terminated early and downgraded by one level owing to the high risk of bias
e The assessment was downgraded by one level because it did not meet the optimal information size and the 95% CI spanned 1.0 to 1.25, which was the threshold for judgment