Efficacy of Nurse-Led Sedation Protocols in Preventing  Ventilator-Associated Pneumonia in Mechanically Ventilated ICU Patients: A Systematic Review

Ling  Shen; Haijie  Li

doi:10.18502/ijph.v54i8.19573

Ling Shen Intensive Care Unit, The First People’s Hospital of Pinghu, Jiaxing, China
Haijie Li Cardiac Rehabilitation Center, Beijing Rehabilitation Hospital, Beijing, China

DOI: https://doi.org/10.18502/ijph.v54i8.19573

Keywords: Ventilator-associated pneumonia; Sedation protocols; Nurse-led intervention nurse practice pattern; Intensive care unit; Mechanical ventilation interactive ventilatory support

Abstract

Background: Ventilator-associated pneumonia (VAP) remains a significant challenge in intensive care units, especially among mechanically ventilated patients. Sedation protocols, particularly nurse-led interventions, have been suggested to improve patient outcomes by reducing the incidence of VAP. This study evaluated the effectiveness of such protocols on VAP incidence, mechanical ventilation duration and ICU length of stay.

Methods: A comprehensive search of electronic databases, including MEDLINE, EMBASE and Cochrane CENTRAL from inception to 30 August 2024 was conducted following PRISMA guidelines. Nurse-led sedation protocols and their impact on VAP outcomes were selected for meta-analysis. Data extraction included sample size, interventions, control measures and primary outcomes. Statistical analysis was performed using a fixed-effects model to calculate risk differences and odds ratios with heterogeneity assessed using the I² statistic.

Results: The systematic review comprised 15 studies, with 7 studies meeting the criteria for meta-analysis. Nurse-led sedation protocols were associated with a significant reduction in the duration of mechanical ventilation (Risk Difference: -0.21; 95% CI: -0.37 to -0.04, P=0.01). However, analyzing VAP-related mortality, the odds ratio (OR: 0.80; 95% CI: 0.60 to 1.07) indicated no statistically significant difference between intervention and control groups (P=0.14).

Conclusion: Nurse-led sedation protocols show promise in reducing the duration of mechanical ventilation, impact on VAP-related mortality remains inconclusive. Future research should focus on refining these protocols and further evaluating their long-term effects on VAP prevention and patient outcomes.