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Implementation of a Risk-Stratified Opioid and Benzodiazepine Weaning Protocol in a Pediatric Cardiac ICU

Rambod Amirnovin1, L Nelson Sanchez-Pinto2, Carol Okuhara3

  • 1Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|September 21, 2018
PubMed

Insights

A new protocol reduced opioid and benzodiazepine exposure in critically ill children with heart disease. This led to shorter treatment durations, fewer withdrawal symptoms, and reduced hospital stays.

Area of Science:

  • Pediatric critical care medicine
  • Cardiology
  • Pharmacology

Background:

  • Opioids and benzodiazepines are standard for analgesia and sedation in critically ill children with cardiac conditions.
  • These medications carry risks, including delirium, dependence, withdrawal, and potential neurodevelopmental issues.

Purpose of the Study:

  • To implement a risk-stratified weaning protocol for opioids and benzodiazepines.
  • To reduce medication exposure in pediatric patients with cardiac disease.

Main Methods:

  • A prospective pre- and postinterventional study design was used.
  • An evidence-based opioid and benzodiazepine weaning protocol was implemented using educational and quality improvement methods.
  • The study included critically ill children (≤21 years) with cardiac disease receiving scheduled opioids ± benzodiazepines for ≥7 days.

Main Results:

  • The postintervention group showed significantly shorter durations of opioid (19.0 vs 30.0 days) and benzodiazepine (5.3 vs 22.7 days) use.
  • Withdrawal occurrence decreased (4.9% vs 14.1%) despite shorter weaning durations.
  • Hospital length of stay was reduced by 8 days (34 vs 42 days).

Conclusions:

  • Implementation of a risk-stratified weaning protocol effectively reduced opioid and benzodiazepine exposure in critically ill pediatric cardiac patients.
  • The protocol led to decreased withdrawal symptoms and a shorter hospital length of stay.
  • This approach offers a strategy to mitigate adverse effects associated with prolonged sedative and analgesic use in this vulnerable population.
Abstract

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