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Delivery of a novel intervention to facilitate liberation from mechanical ventilation in paediatric intensive care: A

Joanne Jordan1, Lyvonne Tume2,3, Mike Clarke4

  • 1School of Health, Wellbeing and Social Care, Open University, Milton Keynes, England.

Plos One
|November 27, 2023
PubMed

Insights

This study reduced invasive mechanical ventilation (IMV) duration in children by optimizing sedation and early liberation protocols. The intervention showed a small but significant decrease in ventilation time, highlighting the importance of clear decision pathways.

Area of Science:

  • Critical Care Medicine
  • Pediatric Intensive Care
  • Clinical Trial Methodology

Background:

  • Prolonged mechanical ventilation is associated with increased mortality and morbidity in critically ill patients.
  • Optimizing sedation and early liberation from mechanical ventilation can reduce ventilator duration.
  • A mixed-methods process evaluation was conducted alongside a multicenter trial to assess intervention delivery and outcomes.

Purpose of the Study:

  • To evaluate the impact of an intervention aimed at optimizing sedation and facilitating early liberation from invasive mechanical ventilation (IMV) in children.
  • To understand the process of intervention implementation and its relationship with trial outcomes through qualitative and quantitative analysis.

Main Methods:

  • A stepped-wedge, cluster randomized controlled trial involving 10,495 children across 18 UK pediatric intensive care units.
  • Intervention included sedation assessment/optimization and bedside screening for spontaneous breathing trials.
  • Qualitative data from 193 staff interviews (thematic analysis) and quantitative adherence data (descriptive statistics) were collected.

Main Results:

  • The intervention resulted in a statistically significant reduction in IMV duration (adjusted median difference -7.1 hours, p=0.01).
  • Overall adherence to the intervention was 75%.
  • Factors promoting use included ease, flexibility, clear responsibilities, decision pathways, and communication; barriers included routines, clinician preference, and lack of leadership.

Conclusions:

  • The SANDWICH trial demonstrated a modest but significant reduction in IMV duration.
  • Enhanced direction in decision-making, integration into unit routines, and leveraging advanced practitioners' skills could improve intervention effectiveness.
Abstract

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