Nasal Tube Research Articles

P121 Use of custom silicone putty device for nasal tube stabilisation in orthognathic surgery to minimise alterations in nasio-labial angle, inter-alar width, and nasal septa distortion, as an alternative to submental intubation

P121 Use of custom silicone putty device for nasal tube stabilisation in orthognathic surgery to minimise alterations in nasio-labial angle, inter-alar width, and nasal septa distortion, as an alternative to submental intubation

Use of custom silicone putty for nasal tube stabilisation in orthognathic surgery

Orthognathic surgery typically contraindicates standard oral intubation techniques. Nasal intubation may distort the nasal profile thus complicating orthognathic surgery involving the midface. Using silicone putty to stabilise the tube in a custom position may minimise these changes. A prospective analysis was undertaken of patients undergoing nasal intubation with and without silicone putty stabilisation. Pre- and post-intubation measurements were made of nasolabial angle and interalar width. Silicone putty significantly reduced the changes of nasal intubation on nasolabial angle (p < 0.001) but did not affect interalar distance (p > 0.05). Silicone putty should be considered to stabilise the nasotracheal tube in orthognathic surgery.

408. COMPARISON OF THE SHORT-TERM EFFICACY OF THORACOSCOPY COMBINED WITH GASTROSCOPY AND TRADITIONAL THORACOTOMY IN THE TREATMENT OF SPONTANEOUS ESOPHAGEAL RUPTURE

Abstract Background Early and thorough intrathoracic debridement，irrigation and catheter drainage are of great significance for the healing of esophageal rupture. This study aims to explore the surgical treatment of spontaneous esophageal rupture, reduce the trauma and improve the cure rate. Methods A total of 21 patients with spontaneous esophageal rupture were selected from June 2010 to June 2022. In the thoracoscopy combined with gastroscopy group, 12 patients were treated with thoracoscopic debridement, esophageal rupture repair, thoracic drainage with closed drainage tube, nasal drainage with gastroscope and nasal duodenal feeding tube placement. In the thoracotomy group, 9 patients performed scheduled thoracotomy. Results Compared with the thoracotomy group, the thoracoscopy combined with gastroscopy group had less incision pain, shorter operation time, less surgical bleeding, and lower incidence of incision infection, pulmonary infection and arrhythmia, with statistical significance (P &amp;lt; 0.05), while the incidence of anastomotic fistula and mortality showed no statistical significance (P &amp;gt; 0.05). Conclusion Spontaneous esophageal rupture is an emergency in thoracic surgery, and the combined operation of thoracoscopy and gastroscopy after early diagnosis has less trauma, faster recovery and good therapeutic effect.

Oral to Nasal Endotracheal Tube Exchange: Modification to Enable Wider Applicability of an "Old Connector" Technique-A Case Report.

Nasotracheal intubation is an essential component of anesthetic management for intraoral and mandibular surgeries. Direct nasotracheal intubation can occasionally be difficult and require an initial oral endotracheal tube (ETT) placement with subsequent conversion to a nasal ETT. Numerous techniques have been described. However, execution can be challenging and limited by available resources. This report re-examines conventional oral to nasal ETT conversion techniques and describes another innovative approach utilizing equipment more readily available in the operating room or as an option when difficulty is encountered with conventional conversion techniques.

STIMA: Submucosal Temporary Inferior Maxillary Antrostomy: A Cadaveric Controlled Study of a Modification of the Conventional Antrostomy.

Introduction: Inferior meatal antrostomy (IMA) is a safe and easy approach to the maxillary sinus. However, studies have shown disadvantages of conventional IMA, such as disruption of mucociliary transport and injury of the nasolacrimal duct (NLD). Endoscopic middle meatal antrostomy (MMA) has become the standard of care for addressing various maxillary pathologies. It is more functional and physiological but offers limited exposure to certain areas of the maxillary sinus, such as the prelacrimal recess, alveolar recess, and zygomatic recess. We proposed submucosal temporary inferior maxillary antrostomy (STIMA) to improve visualization and accessibility to such difficult-to-access locations. Objectives: To describe our proposed modification, to compare the degree of visualization and ease of accessibility between MMA and STIMA. Methods: This is a descriptive cadaveric study. It was performed on 4 fresh frozen human cadavers, and 8 maxillary sinuses were used to achieve the study's objectives. Different angled rigid nasal endoscopes and suction tubes were used to score the degree of visualization and ease of accessibility between the MMA and STIMA. Result: We demonstrated the superiority of the STIMA over the MMA in the degree of visualization and ease of accessibility in these difficult-to-access locations (P-value was significant, <.05). We did not encounter orbital injury or injury to the NLD in our specimens. Conclusion: STIMA is a relatively easy and safe modification of conventional IMA. It improves the degree of visualization and ease of accessibility to difficult-to-access maxillary sinus locations without the potential complications of conventional IMA.

A Bedside Equation to Estimate Endotracheal Tube Length for Infants

To develop a bedside equation that can be used to estimate the ideal oral and nasal endotracheal tube length for children under 1 year of age. Retrospective database analysis of 735 children under 1 year of age admitted to pediatric intensive care (PIC) at Evelina London Children's Hospital (ELCH) from June 1, 2019 through August 31, 2021. Endotracheal tube (ETT) positions were determined by tube tip superimposition over vertebral body on post-intubation chest radiograph by trained medical students and pediatric radiologists with bedside assessment of ETT length at nostril or lip as recorded electronically by nursing staff. The position of 1,176 ETTs were evaluated of which 784 (66%) were nasal and 392 (33%) were oral. After averaging length to account for multiple intubation events per patient, 281 (39%) nasal tubes and 105 (28%) oral tubes were found to be positioned optimally at T2. Using weight was superior to age or corrected age at estimating ETT length. Regression analysis revealed that optimal (T2) positioning of oral ETTs occurs at a length of (weight2+8)cm and in nasal ETTs at (weight2+9.5)cm with a mean absolute prediction error of 5%. The formulae did not require adjustments for those with comorbidities or prematurity. The optimal insertion length of ETTs placed both orally and nasally in children up to 1 year of age can be estimated with appropriate accuracy by a simple bedside formula using weight as the only variable.

Phosphatidylcholine in bile-derived small extracellular vesicles as a novel biomarker of cholangiocarcinoma.

Owing to the lack of definite diagnostic modalities, it is challenging to distinguish malignant cases of cholangiocarcinoma (CCA), which often causes biliary tract obstruction, from benign ones. Here, we investigated a novel lipid biomarker of CCA in bile-derived small extracellular vesicles (sEVs) and developed a simple detection method for clinical application. Bile samples from seven patients with malignant diseases (hilar CCA = 4, distal CCA = 3) and eight patients with benign diseases (gallstones = 6, primary sclerosing cholangitis = 1, autoimmune pancreatitis = 1) were collected through a nasal biliary drainage tube. sEVs were isolated via serial ultracentrifugation and characterized using nanoparticle tracking analysis, transmission electron microscopy, and immunoblotting (with CD9, CD63, CD81, and TSG101). Comprehensive lipidomic analysis was performed using liquid chromatography-tandem mass spectrometry. Using a measurement kit, we further confirmed whether lipid concentrations could be used as a potential CCA marker. Lipidomic analysis of bile sEVs in the two groups identified 209 significantly increased lipid species in the malignant group. When focusing on lipid class, phosphatidylcholine (PC) level was 4.98-fold higher in the malignant group than in the benign group (P = 0.037). The receiver operating characteristic (ROC) curve showed a sensitivity of 71.4%, a specificity of 100%, and an area under the curve (AUC) of 0.857 (95% confidence interval [CI]:0.643-1.000). Using a PC assay kit, the ROC curve showed a cutoff value of 16.1 μg/mL, a sensitivity of 71.4%, a specificity of 100%, and an AUC of 0.839 (95% CI: 0.620-1.000). PC level in sEVs from human bile is a potential diagnostic marker for CCA and can be assessed by a commercially available assay kit.

Endoscopic vacuum therapy in a patient without nasal access.

Usually, upper gastrointestinal (GI) vacuum therapy is delivered through a nasal tube [1]. Herein we report a case in which this access route was not feasible. A 44-year-old man with a previous medical history of a T4aN2M0 extensive squamous-cell lip carcinoma, treated with neoadjuvant chemoradiotherapy followed by tumor resection (including rhinectomy) with surgical defect reconstruction 3 years before admission, was admitted owing to abdominal pain. Computed tomography showed a large pneumoperitoneum. The patient was submitted to an exploratory laparotomy, and a perforated duodenal ulcer was diagnosed and sutured.

Three-arm endoscopic mucosal resection for gastric adenocarcinoma of fundic gland type.

A 65-year-old man was diagnosed with intramucosal carcinoma by endoscopy and pathological biopsy; the tumor was 10 mm in size and located in the greater curvature of the gastric body ([Fig. 1 a]). It was difficult to perform endoscopic submucosal dissection (ESD) on the greater curvature of the gastric body. We therefore proposed a three-arm endoscopic mucosal resection (TA-EMR) technique in which two nasal oxygen tubes, about 80 cm in length, were taped to the outside of the endoscope to become a double additional working channel (AWC) ([Video 1]).

Evaluation of Biochemical Tests in Patients with Severe SARS-CoV 2 Infection and Need for Oxygen Therapy

Abstract Introduction: Since December 2019, when a cluster of pneumonia cases due to SARS-CoV-2 first appeared in China and then rapidly spread worldwide, the need for data on clinical but also paraclinical characteristics of patients with COVID-19 has been highlighted. Method: Between April 15, 2022, and July 31, 2022, 2583 RT-PCR tests were performed in the Emergency Clinical County Hospital Saint Andrei Constanta. Of these 463 were positive, 223 patients were hospitalized in different wards and 70 had severe forms requiring oxygen therapy. The present study aimed to evaluate laboratory data of patients diagnosed with severe SARS-COV2 infection requiring oxygen therapy to detect any parameters associated with more severe forms and reserved prognosis according to previous published research. Results: The patients in the study group were mostly from urban areas, had a mean age of 69.9 years (24-94), 59% were women, and 95.7% of them had associated comorbidities, (38.5% of them had 2 comorbidities and 30% even 3 comorbidities) the most common being hypertension (70%), diabetes mellitus (24.2%) and cardiovascular diseases (31.4%). In the group of patients analyzed showed increases in leukocyte count (48.5%), neutrophil count (52.9%) and decreases in lymphocyte count (72.8%), as well as a degree of anemia in 52.9% of patients. Increased values of inflammatory tests were also recorded: ESR (68.7%), CRP (77.6%), LDH (84%), Fibrinogen (59.3%). D dimers and ferritin were also detected with increased values in 85.7% and 84.2% of patients who had these parameters measured. Increases in urea (57.6%), creatinine (51.6%) and AST (51.6%) were detected but not in ALT. No notable changes in K, Na, AR were detected. Out of the total of 70 patients 45 patients received nasal tube oxygen therapy and the remaining 25 received bilevel positive airway pressure (BiPAP) ventilation. The death rate was 4.3% (3 patients died). CONCLUSIONS: the majority of patients with severe COVID 19 who required hospitalization and oxygen therapy were elderly, had at least one associated comorbidity, high levels of inflammatory tests and D-dimer and ferritin, and tests showing hepatic, renal or pulmonary damage.

Qixue Shuangbu decoction and acupuncture combined with Western medicine in acute severe stroke patients.

Stroke is a common and frequently occurring disease of the nervous system and one of the three major diseases leading to human death. The incidence and mortality of stroke in China increase with age. Overall, 70 % of patients with stroke have serious disability, which results in heavy burden to their families and the society. To analyze the effects of Qixue Shuangbu decoction and acupuncture combined with Western medicine on immune indexes and digestive tract function in patients with acute severe stroke. A total of 68 patients with acute severe stroke admitted to Lanzhou Second People's Hospital between March 2018 and September 2021 were selected and divided into the control and observation groups according to a random number table method. The control group was administered routine Western medicine treatment, such as dehydration, lowering intracranial pressure, anticoagulation, improving cerebral blood circulation and cerebral nerve protection according to the "Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China." The observation group was administered Qixue Shuangbu decoction via nasal feeding tube on the basis of the routine Western medicine treatment with simultaneous acupuncture. The two groups were compared. The acute physiology and chronic health evaluation II, organ dysfunction syndrome score, National Institutes of Health Stroke Scale, and traditional Chinese medicine syndrome scores of the two groups were significantly decreased compared with those measured before treatment, and the complements C3 and C4, and immunoglobulins (Ig) M and G were significantly increased compared with those observed before treatment (P < 0.05). After treatment, the scores of the observation group were lower than those of the control group, and the complement and Ig levels were higher than those of the control group (P < 0.05). The levels of diamine oxidase (DAO), D-lactic acid (D-LA), and calcitonin gene-related peptide (CGRP) in the two groups were significantly higher than those before treatment, while the levels of lipopolysaccharide, ubiquitin carboxyl-terminal hydrolase 1 (UCH-L1), tumor necrosis factor-α (TNF-α), interleukin (IL) -2, and IL-8 were significantly lower than those before treatment (P < 0.05). After treatment, DAO, D-LA, and CGRP were higher in the observation group than in the control group, while lipopolysaccharide, UCH-L1, TNF-α, IL-2, and IL-8 were lower than in the control group (P < 0.05). The hospitalization time of individuals in the observation group was shorter than that of the control group (P < 0.05). Qixue Shuangbu decoction and acupuncture combined with Western medicine for the treatment of acute severe stroke can regulate intestinal flora, reduce inflammation, improve intestinal mucosal barrier function and immune function related indicators, and promote recovery.

Oral to nasal endotracheal tube exchange in patients difficult to undergo laryngoscopy

Oral to nasal endotracheal tube exchange in patients difficult to undergo laryngoscopy

Intra-luminal iodine-125 brachytherapy in patients with esophageal carcinoma and 3/4 dysphagia score: A feasibility study.

To evaluate the clinical results of nasal feeding nutritional tube (NFNT)-loaded iodine-125 (125I) seeds in intra-luminal brachytherapy (ILBT) for esophageal carcinoma (EC) patients with a 3/4 dysphagia score. From January 2019 to January 2020, 26 patients (female/male: 17/9, mean age: 75.3 years, dysphagia score 3/4: 6/20, mean Karnofsky score: 58.4) with EC underwent NFNT-loaded 125I seed placement for both nutrition and brachytherapy. Technical and clinical success, D90 (radiation dose received by 90% of tumor volume) and organ at risk (OAR) dose, complications, dysphagia-free time (DFT), and overall survival (OS) time were documented. Local tumor diameter, Karnofsky score, dysphagia score, and quality of life (QoL) were compared before and 6 weeks after tube placement. Technical and clinical success rates were 100% and 76.9%, respectively. The D90 and OAR doses were 39.7 Gy and 2.3 Gy, respectively. Eight cases (30.8%) experienced mild complications, but no seed loss, fistula, and massive bleeding were observed. Median DFT and OS were 3.1 months and 13.7 months, respectively. Tumor diameter and dysphagia score significantly decreased (p < 0.05), Karnofsky score significantly improved (p < 0.05), and QoL scores related to physical function, physical functioning, general health, vitality, and emotional functioning improved (p < 0.05). NFNT-loaded 125I brachytherapy for ILBT is technically a safe and effective strategy for EC patients with low Karnofsky scores, and can be a bridging therapy for advanced anti-cancer treatment.

The Therapeutic Effect of Swallow Training with a Xanthan Gum-Based Thickener in Addition to Classical Dysphagia Therapy in Chinese Patients with Post-Stroke Oropharyngeal Dysphagia: A Randomized Controlled Study.

In patients with post-stroke oropharyngeal dysphagia (PSOD), classical dysphagia therapy (CDT) continues to provide unsatisfactory outcomes and makes it challenging for them to remove the nasal feeding tube. Increasing bolus viscosity helps prevent aspiration in PSOD. However, conventional starch thickeners enhance post-digestion residue. This study aims to evaluate the efficacy of swallow training with xanthan gum-based thickener (XGT) (Softia G, NUTRI Co., Ltd., Yokkaichi, Japan) additional to CDT in Chinese PSOD patients with a nasogastric tube when compared to CDT alone. Patients with PSOD who had a nasogastric tube were randomly assigned to either the experimental group (E-group) or the control group (C-group) in this randomized controlled, single-blind, parallel-group study. Both groups received CDT for 4 weeks. The E-group cases received additional swallow training with a Softia G-prepared hydrogel training material. The Functional Oral Intake Scale (FOIS) and modified volume-viscosity swallow test (M-VVST) for swallowing safety and efficacy according to adjusted Chinese dietary habits were administered before and after treatment. Post-training, both groups' nasogastric tube removal rates were calculated. One hundred sixty-seven participants (E-group: 82 and C-group: 85) completed the study. The E-group's median score of FOIS improved significantly than the C-group after training (median = 5 vs. 3, P < 0.001). The incidence of coughing, voice changes, oxygen desaturation of 3% or more, pharyngeal residue and piecemeal deglutition in the E-group was significantly lower than that in the C-group (P < 0.05). The E-group had 100% nasogastric tube removal, while the C-group had 28.24% (P < 0.001). Swallow training with XGT Softia G in addition to CDT can promote swallowing safety and efficacy in Chinese patients with PSOD more effectively than CDT alone.

Resource availability and barriers to delivering quality care for newborns in hospitals in the southern region of Malawi: A multisite observational study.

Facility-based births have increased in low and middle-income countries, but babies still die due to poor care. Improving care leads to better newborn outcomes. However, data are lacking on how well facilities are prepared to support. We assessed the availability of human and material resources and barriers to delivering quality care for newborns and barriers to delivering quality care for newborns. We adapted the WHO Service Availability and Readiness Assessment tool to evaluate the resources for delivery and newborn care and barriers to delivering care, in a survey of seven hospitals in southern Malawi between January and February 2020. Data entered into a Microsoft Access database was exported to IBM SPSS 26 and Microsoft Excel for analysis. All hospitals had nursery wards with at least one staff available 24 hours, a clinical officer trained in paediatrics, at least one ambulance, intravenous cannulae, foetal scopes, weighing scales, aminophylline tablets and some basic laboratory tests. However, resources lacking some or all of the time included anticonvulsants, antibiotics, vitamin K, 50% dextrose, oxytocin, basic supplies such as cord clamps and nasal gastric tubes, laboratory tests such as bilirubin and blood culture and newborn clinical management guidelines. Staff reported that the main barriers to providing high-quality care were erratic supplies of power and water, inadequacies in the number of beds/cots, ambulances, drugs and supplies, essential laboratory tests, absence of newborn clinical protocols, and inadequate staff, including paediatric specialists, in-service training, and support from the management team. In hospitals in Malawi, quality care for deliveries and newborns was compromised by inadequacies in many human and material resources. Addressing these deficiencies would be expected to lead to better newborn outcomes.

Semi-occluded Nasal Tract Exercises (SONTEs): Nasal Tube in Water Exercises Using Nasal Consonants

This study analyzes the effects of the vocal exercises called semi-occluded nasal tract exercises (SONTEs), which were carried out with a new appliance that extends the nasal cavity as a part of the vocal tract. The acoustic, aerodynamic and electroglottographic (EGG) measurements were compared with those of the traditional semi-occluded vocal tract exercises (SOVTEs) of phonation in water. In this study, 34 women were randomly asked to perform phonation in water for 5 min through the nasal and oral routes with the sounds /m/ and /ɔ/, respectively, using a tube with a submersion depth of 5 cm. The acoustic, aerodynamic and EGG measurements before and after the exercises were analyzed using the appropriate statistical methods. No significant difference was found in the time and frequency domain parameters before and after the exercises, except for the amplitude perturbation quotient (APQ) values, which decreased after both exercises. In addition, there was no significant difference in any aerodynamic parameters before and after the exercises, but the mean SPL values significantly increased after both exercises. The oral and nasal peak inspiratory flow rates increased after both exercises, but the increase peaked after the SONTEs implementation. As expected, the EGG-jitter and EGG-periodicity values had a reciprocal interaction with each other, while differences were observed between the values of the vocal fold movements measured in both exercises. SONTEs may be as effective as the conventional SOVTEs because it made tube phonation into water possible through artificial extension of the nasal cavity and increased the resonant effect by using the positive effects based on the principles of SOVTEs.

Effectiveness of Different Feeding Techniques for Post-stroke Dysphagia: An Updated Systematic Review and Meta-analysis

PurposeWith the improvement of people’s life expectancy, the incidence of stroke is high in the world. Post-stroke Dysphagia seriously affects people’s quality of life, among which malnutrition and pulmonary infection are the most common complications of post-stroke Dysphagia. At this point, it is very important to choose the right enteral and parenteral feeding mode. Current nutrition methods commonly used in patients with dysphagia after stroke include Intermittent oral to esophageal tube feeding (IOE), Nasogastric tube (NG), Nasal Jejunal feeding tubes (NJ), Percutaneous endoscopic gastrostomy (PEG).The purpose of this meta-analysis was to study the prognosis of patients with dysphagia after stroke who chose different nutritional methods.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTS) to examine the effects of different nutritional modalities on outcomes in patients with post-stroke dysphagia. We searched the Cochrane Library, PubMed, Medline, China National Knowledge Infrastructure (CNKI), Wanfang, and the VIP database. The search period is from the library's establishment to December 31, 2021.At least 2 reviewers independently assessed eligibility criteria, extracted data, and assessed the risk of bias. Standardized mean difference (SMD), relative risk (RR), and odds ratio (OR) were calculated using a random-effects model.ResultsFourteen studies were identified across six databases that met the inclusion criteria, The results of meta-analysis showed that Intermittent oral to esophageal tube feeding (IOE) could improve the nutritional levels of patients better than nasogastric tube (NG) (MD 1.95, 95%CI 1.22–2.67, P < 0.00001, I2 = 0%), and reduced the incidence of aspiration pneumonia (RR 0.39, 95%CI 0.23–0.66, P = 0.0004, I2 = 0%), improved swallowing function (OR 3.92, 95%CI 2.15–7.14, P < 0.00001, I2 = 0%). Although Percutaneous endoscopic gastrostomy (PEG) can improve the nutrition of patients in the short term, the long-term prognosis remains to be discussed. In addition, the Nasal Jejunal feeding tubes (NJ) significantly reduced the incidence of post-stroke pneumonia compared with NG (RR 0.51, 95%CI 0.29–0.92, P = 0.03, I2 = 0%).ConclusionsAccording to the results of meta-analysis, IOE can better improve the nutritional level of patients and reduce the incidence of complications. However, due to the lack of popularity and small target clients, patients who do not accept IOE enteral feeding for various reasons and choose nasal feeding can consider using NJ as a long-term enteral feeding method, and guard against adverse events when performing supplementary nutrition.

Oral to nasal endotracheal tube exchange using tracheal tube guide and video laryngoscope in a pediatric patient with facial burns: a case report

BackgroundAirway management in children with severe burns is difficult because of airway edema and prolonged duration of ventilatory management. There is insufficient evidence to suggest that tracheostomy is beneficial for children.Case presentationA male child aged 1 year and 4 months was injured when he accidentally fell into a bathtub filled with boiling water. Furthermore, 85% of the burnt area, including the face and neck, consisted of second-degree burns; hence, oral tracheal intubation and resuscitative infusion were required. In this case, the patient was safely switched from oral to nasotracheal intubation using a tracheal tube guide and video laryngoscope, without the use of a bronchoscope, and ventilatory management could be continued for 2 weeks.ConclusionOral to nasal endotracheal tube exchange using a tracheal tube guide and video laryngoscope may be useful not only for pediatric burn patients but also for adult patients who need to be safely switched from oral to nasotracheal intubation.

Being an Expert Does Not Mean You Know Everything

Being an Expert Does Not Mean You Know Everything

Pediatric Ventilation Liberation: Bundled Extubation Readiness and Analgosedation Pathways Decrease Mechanical Ventilation Duration and Benzodiazepine Exposure.

Recent studies reported that children on mechanical ventilation who were managed with an analgosedation approach and standardized extubation readiness testing experienced better outcomes, including decreased delirium and invasive mechanical ventilation duration. This was a quality improvement project in a 24-bed pediatric ICU within a single center, including subjects ≤ 18 years old who required invasive mechanical ventilation via an oral or nasal endotracheal tube. The aim was to decrease the invasive mechanical ventilation duration for all the subjects by 25% within 9 months through the development and implementation of bundled benzodiazepine-sparing analgosedation and extubation readiness testing clinical pathways. In the pre-implementation cohort, there were 274 encounters, with 253 (92.3%) that met inclusion for ending in an extubation attempt. In the implementation cohort, there were 367 encounters with 332 (90.5%) that ended in an extubation attempt. The mean invasive mechanical ventilation duration decreased by 23% (Pre 3.95 d vs Post 3.1 d; P = .039) after the implementation without a change in the mean pediatric ICU length of stay (Pre 7.5 d vs Post 6.5 d; P = .42). No difference in unplanned extubation (P > .99) or extubation failure rates (P = .67) were demonstrated. Sedation levels as evaluated by the mean State Behavioral Scale were similar (Pre -1.0 vs Post -1.1; P = .09). The median total benzodiazepine dose administered decreased by 75% (Pre 0.4 vs Post 0.1 mg/kg/ventilated day; P < .001). No difference in narcotic withdrawal (Pre 17.8% vs Post 16.4%; P = .65) or with delirium treatment (Pre 5.5% vs Post 8.7%; P = .14) was demonstrated. A multidisciplinary, bundled benzodiazepine-sparing analgosedation and extubation readiness testing approach resulted in a reduction in mechanical ventilation duration and benzodiazepine exposure without impacting key balancing measures. External validity needs to be evaluated in similar centers and consensus on best practices developed.