Evaluation of nurse-led sedation protocols on clinical outcomes in mechanically ventilated adults within intensive care units: A meta-analysis of randomized controlled trials

BACKGROUND: Many hospitals worldwide implement nurse-led sedation protocols to prevent both underand over-sedation and to enhance comfort and safety for mechanically ventilated patients in intensive care units (ICUs); however, definitive conclusions regarding their effectiveness remain limited. OBJECTIVES: To assess the efficacy of nurse-led sedation protocols on clinical outcomes in mechanically ventilated adults within ICUs. MATERIAL AND METHODS: A systematic search was conducted across 4 electronic databases - PubMed, Embase, Scopus, and the Cochrane Library - to identify relevant studies published in peer-reviewed journals. The standard mean difference (SMD) and risk ratio (RR), along with their corresponding 95% confidence intervals (95% CIs), were calculated. Heterogeneity among studies was assessed using the Cochran's Q test and I2 statistic, with significance determined by the appropriate p-value. All statistical analyses were performed using Review Manager (RevMan) v. 5.4. RESULTS: This meta-analysis of 10 randomized controlled trials (RCTs; n = 1,151 patients) indicates that a nurse-led sedation protocol is significantly more effective than usual care in reducing ICU mortality (RR = 0.34 (95% CI: 0.25 to 0.45); I2 = 38%, p < 0.001), duration of mechanical ventilation (SMD = -1.94 (95% CI: -2.16 to -1.72); I2 = 73%, p < 0.001), length of hospital stay (SMD = -1.70 (95% CI: -1.80 to -1.59); I2 = 79%, p < 0.001), length of ICU stay (SMD = -1.58 (95% CI: -1.76 to -1.40); I2 = 66%, p < 0.001), and incidence of delirium (RR = 0.47 (95% CI: 0.39 to 0.57); I2 = 15%, p < 0.87). CONCLUSION: Compared to usual care, nurse-led sedation protocol can improve ICU mortality and other clinical outcomes in mechanically ventilated ICU patients safely and effectively.