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J Pediatr Intensive Care
DOI: 10.1055/s-0043-1769119
Original Article

Outcomes Associated with a Pediatric Intensive Care Unit Sedation Weaning Protocol

Kimberley Harper
1   Departments of Pediatrics and Pharmacy, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, United States
2   Departments of Pediatrics and Pharmacy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
3   Department of Pediatric Critical Care Medicine, Children's of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi (current institution), United States
,
Jessica Anderson
1   Departments of Pediatrics and Pharmacy, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, United States
,
Julie S. Pingel
1   Departments of Pediatrics and Pharmacy, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, United States
,
Katharine Boyle
1   Departments of Pediatrics and Pharmacy, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, United States
2   Departments of Pediatrics and Pharmacy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Li Wang
2   Departments of Pediatrics and Pharmacy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Christopher J. Lindsell
2   Departments of Pediatrics and Pharmacy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Ann Sweeney
1   Departments of Pediatrics and Pharmacy, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, United States
2   Departments of Pediatrics and Pharmacy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Kristina A. Betters 
1   Departments of Pediatrics and Pharmacy, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, United States
2   Departments of Pediatrics and Pharmacy, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
› Author Affiliations Funding This project was supported in part by CTSA award No. UL1 TR002243 from the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.
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Abstract

Objective This article compares patient outcomes before and after implementation of a risk stratified pediatric sedation weaning protocol.

Methods This observational cohort study, in a 30-bed tertiary care pediatric intensive care unit (PICU), included patients requiring opioid, benzodiazepine, and/or dexmedetomidine infusions. Outcomes (duration of wean, PICU length of stay [LOS], and Withdrawal Assessment Tool [WAT-1] scores) were collected by retrospective chart review for 12 months before and after protocol implementation. The influence of the protocol was assessed using an interrupted time series (ITS) analysis.

Results There were 49 patients before and 47 patients after protocol implementation. Median opioid wean duration preprotocol was 10.5 days (interquartile range [IQR]: 4.25, 20.75) versus 9.0 days (IQR: 5.0, 16.75) postprotocol (p = 0.66). Median benzodiazepine wean duration was 11.5 days (IQR: 3.0, 19.8) preprotocol versus 5.0 days (IQR: 2.0, 13.5) postprotocol (p = 0.31). Median alpha-agonist wean duration was 7.0 days (IQR: 3.5, 17.0) preprotocol versus 3 days (IQR: 1.0, 14.0) postprotocol (p = 0.03). The ITS indicated a reduction in opioid wean by 6.7 days (p = 0.35), a reduction in benzodiazepine wean by 13.4 days (p = 0.12), and a reduction in alpha-agonist wean by 12.9 days (p = 0.06). WAT-1 scores > 3 (12.6% preprotocol vs. 9.9% postprotocol, p = 0.569) and PICU LOS (16.0 days [IQR: 11.0, 26.0] vs. 17.0 days [IQR: 11.0, 26.5], p = 0.796) did not differ between groups.

Conclusion Implementation of a risk stratified sedation weaning protocol in the PICU was associated with a significant reduction in alpha-agonist wean duration without a significant increase in withdrawal symptoms.

Keywords

sedation - weaning - withdrawal - opioids - dexmedetomidine

* Work performed at Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee


Supplementary Material



Publication History

Received: 24 February 2023

Accepted: 17 April 2023

Article published online:
26 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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