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Pediatric Ventilation Liberation: Bundled Extubation Readiness and Analgosedation Pathways Decrease Mechanical

Jeremy M Loberger1, Kristen C Waddell2, Priya Prabhakaran3

  • 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. jloberger@uabmc.edu.

Respiratory Care
|July 12, 2022
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Summary
This summary is machine-generated.

A new analgosedation approach reduced mechanical ventilation duration in children by 23% and benzodiazepine use by 75%. This quality improvement project in a pediatric ICU showed better outcomes without affecting key safety measures.

Keywords:
analgesiabenzodiazepineclinical pathwaysmechanical ventilationopioidpediatrics

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Area of Science:

  • Pediatric Critical Care Medicine
  • Quality Improvement Science
  • Pharmacology

Background:

  • Mechanical ventilation in children can lead to prolonged intensive care unit (ICU) stays and complications like delirium.
  • Previous research suggests analgosedation and readiness testing improve outcomes.
  • Standardized protocols are needed to optimize care for ventilated pediatric patients.

Purpose of the Study:

  • To decrease the duration of invasive mechanical ventilation in pediatric ICU patients by 25% within 9 months.
  • To implement a bundled approach combining benzodiazepine-sparing analgosedation and standardized extubation readiness testing.
  • To evaluate the impact of this bundled approach on key clinical outcomes and safety measures.

Main Methods:

  • A quality improvement project was conducted in a 24-bed pediatric ICU.
  • Inclusion criteria: patients ≤ 18 years old requiring invasive mechanical ventilation.
  • A bundled clinical pathway for benzodiazepine-sparing analgosedation and extubation readiness testing was developed and implemented.

Main Results:

  • Mean invasive mechanical ventilation duration decreased by 23% (3.95 days to 3.1 days, P=.039).
  • Median benzodiazepine dose decreased by 75% (0.4 mg/kg/ventilated day to 0.1 mg/kg/ventilated day, P<.001).
  • No significant changes were observed in pediatric ICU length of stay, unplanned extubation rates, extubation failure rates, or delirium incidence.

Conclusions:

  • A multidisciplinary, bundled approach to analgosedation and extubation readiness testing effectively reduced mechanical ventilation duration and benzodiazepine exposure.
  • The implemented strategy did not negatively impact critical safety outcomes.
  • Further evaluation in diverse settings is recommended to confirm external validity and establish best practices.