Effects of fentanyl administration in mechanically ventilated patients in the intensive care unit: a systematic review and meta-analysis

Table 2 Evidence profiles

Certainty assessment							No. of patients		Effect		Certainty	Importance
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Fentanyl	Other Opioids	Relative (95% CI)	Absolute (95% CI)	Certainty	Importance
Mortality
2	Randomized trials	Not serious	Not serious	Not serious	Very serious ^a	None	4/72 (5.6%)	8/119 (6.7%)	RR 0.79 (0.24 to 2.60)	14 fewer per 1000 (from 51 fewer to 108 more)	⨁⨁◯◯ LOW	CRITICAL
Duration of mechanical ventilation
7	Randomized trials	Not serious	Serious ^b	Not serious	Not serious	None	251	283	-	MD 0.49 higher (0.9 lower to 1.88 higher)	⨁⨁⨁◯ MODERATE	CRITICAL
Duration of the ICU stay
7	Randomized trials	Not serious	Serious ^c	Not serious	Not serious	None	251	283	-	MD 7.04 higher (3.27 lower to 17.35 higher)	⨁⨁⨁◯ MODERATE	CRITICAL
Severe adverse events
4	Randomized trials	Not serious	Not serious	Not serious	Very serious ^a	None	13/173 (7.5%)	15/255 (5.9%)	RR 0.98 (0.50 to 1.90)	1 fewer per 1000 (from 29 fewer to 53 more)	⨁⨁◯◯ LOW	CRITICAL
Delirium
3	Randomized trials	Serious ^d	Not serious	Not serious	Serious ^e	None	30/106 (28.3%)	23/103 (22.3%)	RR 1.27 (0.79 to 2.04)	60 more per 1000 (from 47 fewer to 232 more)	⨁⨁◯◯ LOW	CRITICAL

CI Confidence interval, RR Risk ratio, MD Mean difference, ICU Intensive care unit
^a The assessment was downgraded by two levels because it did not meet the optimal information size and the 95% CI spanned 0.75 to 1.25, which was the threshold for judgment
^b The grade was downgraded by one level because I² for heterogeneity was 93%
^c The grade was downgraded by one level because I² for heterogeneity was 93%
^d Muellejans et al. (28.9% weight of all results) used different sedatives in the intervention and control groups, and Spies et al.’s study (29.2% weight of all results) was terminated early and downgraded by one level owing to the high risk of bias
^e The assessment was downgraded by one level because it did not meet the optimal information size and the 95% CI spanned 1.0 to 1.25, which was the threshold for judgment

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