Protocolised analgosedation in mechanically ventilated adult patients: A scoping review

Our objectives were to assess structure and content of analgosedation protocols used for mechanically ventilated adult patients, including those receiving extracorporeal membrane oxygenation (ECMO), against current international sedation guidelines, and to explore reported barriers and facilitators to their implementation.

Scoping review searching five databases (December 1999 to September 2026). We included all study types reporting on analgosedation protocol structure and content, and/or implementation barriers/facilitators. Two authors independently screened citations, extracted data, and coded reported barriers and facilitators using the Theoretical Domains Framework.

We screened 18,457 citations with 81 studies meeting inclusion criteria. Of these, 35 (43%) were observational studies, 27 (33%) non-randomised interventional studies, and 19 (23%) randomised controlled trials. Few studies published between 2019 and 2026 included propofol or dexmedetomidine, multi-modal analgesia and delirium assessment in analgosedation protocols, and no studies in ECMO patients. The most frequently reported structure and content of protocol was use of a sedation score (77%), recommending opioid and sedative drugs (74%), and setting a daily target sedation score (65%). Most reported barrier was a protocol insufficiently detailed to cover the breadth of patient needs, reported in 12 (63%) studies. The most frequently reported facilitator was availability of the analgosedation protocol in an easily accessible format, reported in four (31%) studies.

Easy to follow protocols sufficiently detailed to cover patient need from a heterogenous ICU population are considerations to successful implementation. Healthcare staff fear of adverse effects is a potential barrier to adoption of protocolised analgosedation.