Download PDF
CC BY-NC-ND 4.0 · J Pediatr Intensive Care
DOI: 10.1055/s-0043-1774306
Original Article

Effect of Target-Driven Sedation Protocol to Ventilator Liberation in Pediatric Intensive Care Unit: Pre- and Postimplementation Single-Center Study

Abdulla Alfraij 
1   Pediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser, Al Farwaniya Governorate, Kuwait
2   Pediatric Intensive Care Unit, Department of Pediatrics, Ahmadi Hospital, Kuwait Oil Company, Al Ahmadi, Kuwait
,
Ahmed Abdelmoniem
1   Pediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser, Al Farwaniya Governorate, Kuwait
,
Mohammad Surour
1   Pediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser, Al Farwaniya Governorate, Kuwait
,
Mohamed Basuni
1   Pediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser, Al Farwaniya Governorate, Kuwait
,
Mohamed Elseadawy
1   Pediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser, Al Farwaniya Governorate, Kuwait
› Author Affiliations Financial Supporting This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
› Further Information
   Permissions and Reprints

Abstract

Oversedation of mechanically ventilated children is common in many pediatric intensive care units (PICUs). This practice is driven by the challenges of dealing with children of different ages as they have different behavioral, mental, and emotional statuses. We aimed to evaluate the effect of implementing a target-driven sedation protocol in the PICU on ventilator-free days (VFDs), PICU stays, and hospitalization. A 2-year retrospective cohort study was performed in our PICU between October 1, 2018, and October 1, 2020. All intubated children up to 12 years of age were included. Descriptive analyses and a pre- and postintervention comparison of VFDs and length of stay were used to assess the protocol's effectiveness. A total of 134 patients were studied. There was a significant increase in VFDs in cases with respiratory illness requiring mechanical ventilation after implementing this protocol (19.9 vs. 22.3, respectively, with a p-value of 0.031). Also, there was a trend of reduction in the length of PICU stay (median of 9 vs. 8 days, p = 0.816), post-PICU length of stay (median of 4 vs. 3 days, p = 0.055), and hospitalization duration (median of 16 vs. 13 days, p = 0.062) though not statistically significant. Implementing a target-driven sedation protocol in the PICU significantly affects VFDs in mechanically ventilated respiratory cases. Though inconclusive in our study, implementing such a protocol will influence patients' care and reduce unnecessary sedation uses that will reduce sedation hazards.

Keywords

ventilator liberation - target-driven sedation - sedation during mechanical ventilation - pediatric - intensive care unit

Authors' Contribution

A.A. contributed to conceptualization, methodology, investigation, data curation, writing—original draft, and supervision. A.A., M.S., M.B., and M.E. helped in investigation—data collection, writing—review and editing.




Publication History

Received: 18 July 2023

Accepted: 04 August 2023

Article published online:
19 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Mehta S, McCullagh I, Burry L. Current sedation practices: lessons learned from international surveys. Anesthesiol Clin 2011; 29 (04) 607-624
    CrossrefPubMedGoogle Scholar
  • 2 Aragón RE, Proaño A, Mongilardi N. et al. Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort. Crit Care 2019; 23 (01) 130
    CrossrefPubMedGoogle Scholar
  • 3 Hager DN, Dinglas VD, Subhas S. et al. Reducing deep sedation and delirium in acute lung injury patients: a quality improvement project. Crit Care Med 2013; 41 (06) 1435-1442
    CrossrefPubMedGoogle Scholar
  • 4 Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 2007; 33 (01) 66-73
    CrossrefPubMedGoogle Scholar
  • 5 Ely EW, Shintani A, Truman B. et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291 (14) 1753-1762
    CrossrefPubMedGoogle Scholar
  • 6 Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med 2009; 180 (11) 1092-1097
    CrossrefPubMedGoogle Scholar
  • 7 Lin SM, Liu CY, Wang CH. et al. The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med 2004; 32 (11) 2254-2259
    CrossrefPubMedGoogle Scholar
  • 8 Girard TD, Jackson JC, Pandharipande PP. et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 2010; 38 (07) 1513-1520
    CrossrefPubMedGoogle Scholar
  • 9 Jackson JC, Girard TD, Gordon SM. et al. Long-term cognitive and psychological outcomes in the awakening and breathing controlled trial. Am J Respir Crit Care Med 2010; 182 (02) 183-191
    CrossrefPubMedGoogle Scholar
  • 10 Harris J, Ramelet AS, van Dijk M. et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals. Intensive Care Med 2016; 42 (06) 972-986
    CrossrefPubMedGoogle Scholar
  • 11 Choong K. PICU-acquired complications: the new marker of the quality of care. ICU Management & Practice. 2019; 19 (02) 85-88
    PubMedGoogle Scholar
  • 12 Egbuta C, Mason KP. Current state of analgesia and sedation in the pediatric intensive care unit. J Clin Med 2021; 10 (09) 1847
    CrossrefPubMedGoogle Scholar
  • 13 Smith HAB, Besunder JB, Betters KA. et al. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatr Crit Care Med 2022; 23 (02) e74-e110
    CrossrefPubMedGoogle Scholar
  • 14 Kudchadkar SR, Yaster M, Punjabi NM. Sedation, sleep promotion, and delirium screening practices in the care of mechanically ventilated children: a wake-up call for the pediatric critical care community. Crit Care Med 2014; 42 (07) 1592-1600
    CrossrefPubMedGoogle Scholar
  • 15 Koizumi T, Kurosawa H. Survey of analgesia and sedation in pediatric intensive care units in Japan. Pediatr Int 2020; 62 (05) 535-541
    CrossrefPubMedGoogle Scholar
  • 16 Annual Health Report. Kuwait: National Center for Health Information, Ministry of Health; 2020
    Google Scholar
  • 17 Yehya N, Harhay MO, Curley MAQ, Schoenfeld DA, Reeder RW. Reappraisal of ventilator-free days in critical care research. Am J Respir Crit Care Med 2019; 200 (07) 828-836
    CrossrefPubMedGoogle Scholar
  • 18 Khemani RG, Markovitz BP, Curley MAQ. Characteristics of children intubated and mechanically ventilated in 16 PICUs. Chest 2009; 136 (03) 765-771
    CrossrefPubMedGoogle Scholar
  • 19 Arroyo-Novoa CM, Figueroa-Ramos MI, Puntillo KA. Opioid and benzodiazepine iatrogenic withdrawal syndrome in patients in the intensive care unit. AACN Adv Crit Care 2019; 30 (04) 353-364
    CrossrefPubMedGoogle Scholar
  • 20 Hopkins RO, Choong K, Zebuhr CA, Kudchadkar SR. Transforming PICU culture to facilitate early rehabilitation. J Pediatr Intensive Care 2015; 4 (04) 204-211
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Newth CJ, Venkataraman S, Willson DF. et al; Eunice Shriver Kennedy National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med 2009; 10 (01) 1-11
    CrossrefPubMedGoogle Scholar
  • 22 Gaillard-Le Roux B, Liet JM, Bourgoin P, Legrand A, Roze JC, Joram N. Implementation of a nurse-driven sedation protocol in a PICU decreases daily doses of midazolam. Pediatr Crit Care Med 2017; 18 (01) e9-e17
    CrossrefPubMedGoogle Scholar
  • 23 van Keulen JG, Polderman KH, Gemke RJ. Reliability of PRISM and PIM scores in paediatric intensive care. Arch Dis Child 2005; 90 (02) 211-214
    CrossrefPubMedGoogle Scholar
  • 24 Shen Y, Jiang J. Meta-analysis for the prediction of mortality rates in a pediatric intensive care unit using different scores: PRISM-III/IV, PIM-3, and PELOD-2. Front Pediatr 2021; 9: 712276
    CrossrefPubMedGoogle Scholar