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Table 1 Impact of sedation practice on patient safety outcomes

From: A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety

Study Study type Sample size Comparison Percentage mortality rate, timepoint for measurement and P value for comparison Incidence of nosocomial pneumonia (%) Accidental extubation rate (%) Re-intubation rate
Marshall and colleagues 2008 [18] Introduction of protocol (before-after study) 156 Before Hospital mortality: 18%   10% (self-extubation) 11.5%
    After active pharmacist intervention Hospital mortality: 15%
P = 0.83
  4% (self-extubation) P = 0.2 10.3%
P = 0.8
Quenot and colleagues 2007 [20] Introduction of protocol (before-after study) 423 Before ICU mortality: 39%
Hospital mortality: 45%
15% (ventilator -- associated pneumonia) 7 (unscheduled self-extubation)  
    After introduction of nurse-led sedation protocol ICU mortality: 32%
P = 0.19
Hospital mortality: 38% P = 0.22
6% (ventilator -- associated pneumonia)
P = 0.005
11 (unscheduled self-extubation) P = 0.09  
Arabi and colleagues 2007 [10] Introduction of protocol (before-after study) 207 Before education -- no protocol ICU mortality: 20%
Hospital mortality: 24%
28%   
    Before education -- protocol ICU mortality: 18%
Hospital mortality: 24%
29%   
    After education -- no protocol ICU mortality: 23%
Hospital mortality: 36%
11%   
    After education - protocol ICU mortality: 13% P = 0.64 for all comparisons
Hospital mortality: 23%
P = 0.35 for all comparisons
11%
P = 0.02
  
Chanques and colleagues 2006 [13] Introduction of protocol (before-after study) 230 Before ICU mortality: 12% 14% 4% (self-extubation)  
    After monitoring of agitation ICU mortality: 15%
P = 0.76
9%
P = 0.31; P = 0.03 for events/1000 ventilation days
2% (self-extubation) P = 0.65  
Burns and colleagues 2003 [3] Introduction of protocol (before-after study) 1105 Before 38% (timepoint unclear)   10%  
    After introduction of outcomes management protocol 31%
P = 0.02 (timepoint unclear)
  7%  
Mascia and colleagues 2000 [19] Introduction of protocol (before-after study) 156 Before 16.7% (timepoint unclear)    
    After introduction of protocol 17.6%
P = 0.89 (timepoint unclear)
   
Jakob and colleagues 2007 [16] Introduction of protocol (before-after study) 300 After implementation of intervention 1 (change in ICU organisation) ICU mortality: 19%    
    After implementation of intervention 2 (introduction of protocols for weaning) ICU mortality: 8%    
    After implementation of intervention 1 (change in ICU organisation) ICU mortality: 7%
P = 0.02
   
De Jonghe and colleagues 2005 [14] Introduction of protocol (before-after study) 102 Before   8%   
    After introduction of protocol   20.4%
P = 0.1
  
Brattebo and colleagues 2002; 2004 [11, 28] Introduction of protocol (before-after study) 285 Before ICU mortality: 27%   0  
    After introduction of protocol ICU mortality: 22% (not significant)   0  
Brook and colleagues 1999 [12] Introduction of protocol (before-after study) 321 Before Hospital mortality: 36%    9%
    After introduction of protocol Hospital mortality: 30%    13% P = 0.213
Kress and colleagues 2000; 2001; Schweickert and colleagues 2004 [4, 22, 29] RCT of daily interruption of sedation 128 Continuous sedation Hospital mortality: 47% 8% (ventilator-associated pneumonia)   
    Sedation interrupted daily Hospital mortality: 36%
P = 0.25
3% (ventilator-associated pneumonia)   
Girard and colleagues 2008 [6] RCT of spontaneous breathing trials with and without daily interruption of sedation 335 Continuous sedation + spontaneous breathing trial 28-day mortality: 35%
1-year mortality: 58%
  10% self-extubations
3% required re-intubation
14%
    Sedation interrupted daily + spontaneous breathing trial 28-day mortality: 28%
P = 0.21
1-year mortality: 44%
P = 0.01
  4% self-extubation P = 0.03
2% required re-intubation
P = 0.47
13%
P = 0.73
Kollef and colleagues 1998 [5] Continuous sedation vs intermittent sedation 242 Continuous sedation Hospital mortality: 34%    15%
    Sedation interrupted daily Hospital mortality: 30%
P = 0.58
   5% P = 0.005
Carson and colleagues 2006 [8] RCT of intermittent lorazepam vs. continuous propofol 132 Lorazepam Hospital mortality: 38%   2% self-extubations 16% reintubations
    Propofol Hospital mortality: 37%   5% self-extubations P = 0.62 12% reintubations P = 0.59
Pandharipande and colleagues 2007a, b; 2006 [24, 30, 31] RCT of dexmedetomidine vs lorazepam (RASS individualised to each patient) 103 Dexmedetomidine 28-day mortality: 17%   8%  
    Lorazepam 28-day mortality: 27%
P = 0.18
  4% P = 0.41  
  1. RASS, Richmond agitation sedation scale; RCT, randomised controlled trial.