ABSTRACT Background Current evidence indicates that suboptimal analgesia and sedation management by ICU healthcare professionalss stems from a combination of knowledge gaps, low adherence to guidelines, high workload and concerns over patient safety. Aim To identify and synthesise evidence on ICU clinicians' perceptions regarding barriers and facilitators to analgesia‐sedation management, and to derive implementation strategies to support practice improvement. Study Design Mixed‐methods systematic review. We systematically searched eight databases (PubMed, EMBASE, Web of Science, CINAHL, Cochrane Library, CNKI, Wan fang, Sino Med and VIP) until September 2025 for studies exploring barriers and facilitators to analgesia‐sedation management in the ICU. Two researchers independently screened studies, extracted data and assessed quality using the Mixed Methods Appraisal Tool (MMAT). Thematic synthesis was conducted using the Consolidated Framework for Implementation Research (CFIR) framework, with findings mapped to Expert Recommendations for Implementing Change (ERIC) strategies. Results The initial search identified 4821 records. After screening, 36 studies were finally included (comprising 28 quantitative studies, 7 qualitative studies and 1 mixed‐methods study). The methodological quality of the included studies was assessed as relatively high. Sixteen barrier factors and 7 facilitator factors were extracted from the included literature and categorised into four core themes: Organisational Management and Resource Support, Education and Training and Knowledge Systems, Beliefs and Perceptions and Willingness to Change and Clinical Practice and Collaborative Execution. Mapping the barrier factors to the CFIR framework revealed that ‘Inner Setting’ factors significantly influenced all themes except ‘Organizational Management and Resource Support’. Based on the CFIR mapping results, 10 implementation strategies with expert consensus ratings above 50% were selected from the ERIC strategy library. These strategies were elaborated in detail by integrating the facilitator factors extracted from the literature. Conclusions Effective implementation requires barrier‐informed strategies. We developed a targeted strategy set through CFIR‐ERIC mapping. The findings consolidate evidence on effective analgesia‐sedation strategies, providing a reference for clinical practice in the ICU. Future work should develop multi‐component interventions and evaluate their effectiveness and sustainability. Relevance to Clinical Practice This study provides evidence‐based strategies for managing analgesia and sedation in the ICU, informing clinical decisions. Registration The protocol was registered with PROSPERO in October 2025 (registration number: CRD420251230829).
Shi et al. (Thu,) studied this question.