• Ya Nee Poh, Pei Fen Poh, Siti Nur Hanim Buang, and Jan Hau Lee.
• 1Division of Nursing, Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore. 2Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children Hospital, Singapore. 3Office of Clinical Sciences, Duke-NUS Graduate School of Medicine, Singapore.
• Pediatr Crit Care Me. 2014 Nov 1; 15 (9): 885892885-92.

ObjectiveTo evaluate the impact of sedation guidelines, protocols, and algorithms on clinical outcomes in PICUs.Data SourcesCINAHL, Medline, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews,Study Selection: English-only publications from 1966 to December 2013, which included keywords "sedation," "guideline," "algorithm," "protocol," and "pediatric intensive care." We included all primary studies involving critically ill children on sedation guidelines, protocols, and algorithms and excluded those which focused mainly on diagnostic or procedural purposes.Data ExtractionTwo authors independently screened each article for inclusion. A standardized data extraction sheet was used to extract data from all included studies.Data SynthesisAmong the 1,283 citations yielded from our search strategy, six observational studies were included in the final review. Due to the heterogeneity of the studies included, clinical outcomes were not combined into a meta-analysis. A descriptive account of the studies was formulated to characterize all included studies. The three outcomes of interest were clinical outcomes, patients' comfort and safety, and sedative use. We found an association between the use of sedation guidelines, protocols, and algorithms and reduced PICU length of stay, frequency of unplanned extubation, prevalence of patients experiencing drug withdrawal, total sedation duration, and doses. Overall, the quality of identified studies is low.ConclusionsDespite widespread recommendation for the use of sedation guidelines, protocols, and algorithms in critically ill children, our systematic review revealed a paucity of high-quality evidence to guide this practice. More robust studies are urgently needed for this important aspect of PICU care.

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