Abstract
We sought to evaluate the success rate of a benzodiazepine-sparing analgosedation protocol (ASP) in mechanically ventilated children and determine the effect of compliance with ASP on in-hospital outcome measures. In this single center study from a quaternary pediatric intensive care unit, our objective was to evaluate the ASP protocol, which included opiate and dexmedetomidine infusions and was used as first-line sedation for all intubated patients. In this study we included 424 patients. Sixty-nine percent (n = 293) were successfully sedated with the ASP. Thirty-one percent (n = 131) deviated from the ASP and received benzodiazepine infusions. Children sedated with the ASP had decrease in opiate withdrawal (OR 0.16, 0.08–0.32), decreased duration of mechanical ventilation (adjusted mean duration 1.81 vs. 3.39 days, p = 0.018), and decreased PICU length of stay (adjusted mean 3.15 vs. 4.7 days, p = 0.011), when compared to the cohort of children who received continuous benzodiazepine infusions. Using ASP, we report that 69% of mechanically ventilated children were successfully managed with no requirement for continuous benzodiazepine infusions. The 69% who were successfully managed with ASP included infants, severely ill patients, and children with chromosomal disorders and developmental disabilities. Use of ASP was associated with decreased need for methadone use, decreased duration of mechanical ventilation, and decreased ICU and hospital length of stay.
Highlights
Recent studies have demonstrated a consistent and robust association between exposure to benzodiazepines and delirium development in pediatric critical illness [1,2,3,4,5]
As pediatric delirium is related to poor outcomes, there is a compelling need to explore alternatives to benzodiazepine-based sedation in mechanically ventilated children [6,7,8]
It is possible that the favorable outcomes we describe in association with the analgosedation protocol (ASP) may have resulted from decreased delirium risk, and not the ASP itself
Summary
Recent studies have demonstrated a consistent and robust association between exposure to benzodiazepines and delirium development in pediatric critical illness [1,2,3,4,5]. As of 2013, most pediatric critical care units were still using midazolam as first-line sedation in mechanically ventilated children [11,12,13]. The perceived benefits of midazolam infusion from previous studies include minimal physiological alteration in the critically ill patient, short duration of action without accumulation or active metabolites, flexibility in route of administration (can be given enterally, intranasally, rectally) if intravenous access is interrupted. Limited evidence exists as to which critically ill children will succeed with a benzodiazepine-sparing analgosedation (ASP) protocol during mechanical ventilation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
