A systematic review and critical appraisal of guidelines and their recommendations for sedation interruptions in adult mechanically ventilated patients |
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| Affiliation: | 1. University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada;2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada;3. Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada;4. Department of Medicine, University of Ottawa, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 711, Ottawa ON, K1H 8L6, Canada |
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| Abstract: | ObjectiveThe objectives of the review were to (i) assess the methodological quality of all accessible and published guidelines and care bundles that offer a recommendation related to sedation interruptions, using the AGREE-II instrument, to (ii) determine what is the recommended best practice for sedation interruptions from the available guidelines, and then to have (iii) a closer inspection of the overall credibility and applicability of the recommendations using the AGREE-REX instrument. This review will benefit the outcomes of critically ill patients and the multidisciplinary team responsible for the care of mechanically ventilated adults with continuous medication infusions by providing a synthesis of the recommended action(s), actor(s), contextual information, target(s), and timing related to sedation interruptions from current best practice.Review method usedWe conducted a systematic review.Data sourcesWe applied a peer-reviewed search strategy to four electronic databases from 2010 to November 2021—MEDLINE, CINAHL, Embase, and The Cochrane Database of Systematic Reviews—and included grey literature.Review methodFindings are reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses checklist. We assessed overall quality using the validated Appraisal of Guidelines for Research and Evaluation II and AGREE Recommendation Excellence tools.ResultsWe identified 11 clinical practice guidelines and care bundles comprising 15 recommendations related to sedation interruption. There are three key findings: (i) deficiencies exist with the methodological quality of included guidelines, (ii) sedation interruption is recommended practice for the care of adult mechanically ventilated patients, and (iii) the current evidence is of low quality, which impacts overall credibility and applicability of the recommendations.ConclusionsSedation interruptions are currently best practice for adult mechanically ventilated patients; however, the available guidelines and recommendations have several deficiencies. Future research is needed to further understand the role of the nurse and other actors to enact this practice. |
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| Keywords: | AGREE-II AGREE-REX Guideline quality Best practice Critical care Intensive care Sedation interruption Mechanical ventilation Nurses |
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