Impact of Nurse-Driven Analgesia and Sedation Protocols on Medication Exposure and Withdrawal in Critically Ill Children: A Systematic Review.

Only 10 studies were included, and nine were single-arm before-and-after studies without control groups. Risk of bias was serious or critical in many studies, with confounding and selective reporting problems. Heterogeneity in populations, drugs, dosages, units and withdrawal scales prevented meta-analysis, so results are a narrative synthesis. Protocols varied widely in nurse autonomy, training, weaning strategies and medications, so the effect of nurse-driven titration alone cannot be isolated. Search was limited to four databases, English language and the last 10 years, which may have missed relevant studies. Some positive findings came from subgroup or secondary analyses, such as ventilation duration in older children or lower-risk cardiac patients, not from the main medication-exposure outcome. Neonatal and ECMO populations were excluded, so findings may not apply to them.

The authors declared no conflicts of interest. The work was funded by Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato.

Do not conclude that nurse-driven protocols reliably reduce opioid exposure or ventilation time. Opioid reductions were inconsistent, and the cluster-randomised trial found median ventilation duration of 6.5 days in both groups.