Evaluation of a sedation protocol for intubated critically ill children

The aim of this study was to conduct an evaluation of a sedation protocol that transfers some decision-making authority for analgesia and sedation, within clearly defined parameters, to nurses in a pediatric intensive care unit (PICU). The sedation protocol used in this study was appropriate for any age group. The clinical course of 10 patients admitted to the PICU during a 5-month interval who were on the sedation protocol during their stay was examined using retrospective chart review. Time intervals when patients were on the protocol were compared with clinically comparable time intervals, in terms of acuity, when the same patient received conventional management. Data were collected on the number of days a child was ventilated, the number of days in the PICU, the number of days hospitalized and severity of illness. Additionally, data were collected on the amounts of sedation and analgesia required and the incidence of under-sedation. Physician and nurse satisfaction with the sedation protocol was examined using a self-report survey. The findings of this study indicate that the delegation of decision-making authority for analgesia and sedation to PICU nurses can provide effective and timely management of patient comfort, without an increase in morbidity, in a manner that is more satisfying for physicians and nurses.