Evaluation of Objective Sedation Monitoring Practices in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
OBJECTIVES: To conduct a systematic review and meta-analysis to determine if objective sedation monitoring practices reduce duration of mechanical ventilation and other clinical and healthcare utilization outcomes in critically ill adult patients. DATA SOURCES: Ovid MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, Cochrane Library and PROSPERO, and the grey literature. STUDY SELECTION: Observational or interventional original research studies, conducted in adult critically ill patients undergoing invasive mechanical ventilation, evaluating any objective sedation monitoring practice (e.g., electroencephalography [EEG]), and reporting on duration of mechanical ventilation or other secondary outcomes (e.g., length of stay) were included. DATA EXTRACTION: Meta-analysis was performed for pooled estimates of the primary outcome and each individual secondary outcome using random-effects modeling. DATA SYNTHESIS: Twenty studies (3410 patients) were included with 15 studies evaluating processed EEG monitoring, 2 evaluating EEG monitoring, and 3 evaluating processed facial electromyography (EMG). Processed EEG was not associated with reduced duration of mechanical ventilation (standardized mean difference [SMD] -0.33; 95% CI, -0.91 to 0.25; I2 = 84.4%). Secondary outcomes of processed EEG monitoring showed decreased hospital length of stay (days) (SMD -0.89; 95% CI, -1.17 to -0.62; I2 = 13.4%), reduced total sedative dose (reported in propofol equivalents, mg) (SMD -1.29; 95% CI, -2.27 to -0.31; I2 = 96.6%), and reduced total opioid dose (reported in morphine equivalents, mg) (SMD -0.40; 95% CI, -0.76 to -0.04; I2 = 77.0%). Processed facial EMG was associated with an increased risk of adverse events (risk ratio 1.40; 95% CI, 1.03-1.90; I2 = 0.00%). Risk of bias was serious for 65% (n = 13/20) of included studies. CONCLUSIONS: Processed EEG monitoring is not associated with reduced duration of mechanical ventilation but may be associated with reduced sedative and opioid exposure and decreased hospital length of stay. Processed facial EMG monitoring may be associated with increased adverse events.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.474 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".