Related Experiment Videos

Adherence to Sedative Weaning Opportunities and Length of Stay for Critically Ill Children

Taylor M Smith1,2, Franklin Ducatez1,2,3, Barbara Jo Achuff4,5

  • 1Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.

JAMA Network Open
|August 21, 2026
PubMed

Insights

Pediatric intensive care unit (ICU) clinicians had low adherence to sedative weaning opportunities. Improving adherence to sedative weaning can shorten ICU and hospital stays and reduce sedative exposure in critically ill children.

Area of Science:

  • Pediatric critical care medicine
  • Pharmacology
  • Clinical outcomes research

Background:

  • Prolonged sedative exposure in pediatric intensive care units (PICUs) is linked to adverse outcomes like delirium, withdrawal, and neurodevelopmental impairment.
  • Clinical guidelines advocate for timely sedative weaning, but adherence to these opportunities and its impact on patient outcomes remain unclear.

Purpose of the Study:

  • To assess adherence to sedative weaning opportunities in pediatric ICUs.
  • To examine the association between weaning adherence and clinical outcomes, including length of stay and sedative exposure.

Main Methods:

  • A multicenter cohort study analyzed data from over 15,000 ICU encounters in pediatric academic medical centers.
  • Weaning adherence was calculated as the percentage of identified weaning opportunities resulting in dose reduction or discontinuation.
  • Multivariable regression models adjusted for patient and center-level factors to assess the association between weaning adherence and outcomes.

Main Results:

  • Overall adherence to sedative weaning opportunities was low at 28%, with missed opportunities being common (72%).
  • Higher weaning adherence was significantly associated with shorter ICU length of stay (–2.3 days per 10% increase) and hospital length of stay (–3.6 days per 10% increase).
  • Increased adherence also correlated with reduced sedative infusion duration and lower cumulative exposure to opioids, benzodiazepines, and alpha-2 agonists.

Conclusions:

  • Adherence to sedative weaning protocols in pediatric ICUs is suboptimal.
  • Improving adherence to sedative weaning opportunities is independently associated with reduced length of stay and sedative exposure.
  • Targeting weaning adherence presents a potential modifiable strategy to improve clinical outcomes for critically ill children.
Abstract

Related Concept Videos

Stages of General Anesthesia01:22

Stages of General Anesthesia

Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
Endotracheal Tube Extubation01:24

Endotracheal Tube Extubation

Endotracheal tube extubation is a critical procedure in weaning patients from mechanical ventilation. It involves physically removing the oral or nasal endotracheal (ET) tube, marking the final step in liberating a patient from ventilatory support.
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals.
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
Sedatives and Hypnotics: Overview01:23

Sedatives and Hypnotics: Overview

Sedatives are drugs that alleviate anxiety, while hypnotics induce sleep. Both classes of medication suppress neuronal activity, leading to a calming effect for sedatives and facilitating sleep for hypnotics.
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
CNS Depressants: Barbiturates and Benzodiazepines01:14

CNS Depressants: Barbiturates and Benzodiazepines

CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...