Implementation of a Nurse-Driven Sedation Protocol in a PICU Decreases Daily Doses of Midazolam

Roux, Bénédicte Gaillard-Le; Liet, Jean-Michel; Bourgoin, Pierre; Legrand, Arnaud; Rozé, Jean‐Christophe; Joram, Nicolas

doi:10.1097/pcc.0000000000000998

Cited by 37 publications

(38 citation statements)

References 35 publications

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“…In this setting, any modification of sedation or analgesia had to be validated by the physician. Recently, Gaillard-Le Roux et al [30] showed in a paediatric study that a nurse-driven protocol was also applicable for deeply sedated patients, with lower target scores. Generalising the use of the protocol to all patient categories is certainly a good manner to enhance its acceptability and its efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…infants weighting less than 10 kg as well as children and teenagers weighing sometimes more than 80 kg), and there are probably important differences, especially pharmacologic ones, according to the age and to the reason for admission. A recent French paediatric study showed in a subgroup analysis a shorter length of mechanical ventilation among children older than 12 months after implementation of the protocol [30]. The only large RCT published on this subject [18] included patients with ARDS only, who present specific characteristics: long respiratory recovery, use of deep sedation and neuromuscular blockades; in consequence, their results could not be generalised to the overall PICU population.…”

Section: Discussionmentioning

confidence: 99%

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Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit

Dreyfus

Javouhey

Denis

et al. 2017

Ann. Intensive Care

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BackgroundOptimal sedation and analgesia is a challenge in paediatric intensive care units (PICU) because of difficulties in scoring systems and specific metabolism inducing tolerance and withdrawal. Excessive sedation is associated with prolonged mechanical ventilation and hospitalisation. Adult and paediatric data suggest that goal-directed sedation algorithms reduce the duration of mechanical ventilation. We implemented a nurse-driven sedation protocol in a PICU and evaluated its impact.MethodsWe conducted a before and after protocol implementation study in a population of children aged 0–18 years who required mechanical ventilation for at least 24 h between January 2013 and March 2015. After the protocol implementation in January 2014, nurses managed analgesia and sedation following an algorithm that included the COMFORT behaviour scale (COMFORT-B). Duration of mechanical ventilation was the primary outcome; secondary outcomes were total doses and duration of medications, PICU length of stay, incidence of ventilator-associated pneumonia, and occurrence of withdrawal symptoms. Pre–post analysis followed with segmented regression analysis of interrupted time series was used to assess the effect of protocol.ResultsA total of 200 children were analysed, including 107 before implementation and 93 children after implementation of the protocol. After implementation of the protocol, the total number of COMFORT-B scores per day of mechanical ventilation significantly increased from 3.9 ± 2.5 times during the pre-implementation period to 6.6 ± 3.5 times during the post-implementation period (p < 10−3). Mean duration of mechanical ventilation tended to be lower in the post-implementation period (8.3 ± 7.3 vs 6.6 ± 5.6 days, p = 0.094), but changes in either the trend per trimester from pre-implementation to post-implementation (p = 0.933) or the immediate change after implementation (p = 0.923) were not significant with segmented regression analysis. No significant change between pre- and post-implementation was shown for total dose of sedatives, withdrawal symptoms, agitation episodes, or unplanned endotracheal extubations.ConclusionsThese results were promising and suggested that implementation of a nurse-driven sedation protocol in a PICU was feasible. Evaluation of sedation and analgesia was better after the protocol implementation; duration of mechanical ventilation and occurrence of withdrawal symptoms tended to be reduced.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0256-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit

Dreyfus

Javouhey

Denis

et al. 2017

Ann. Intensive Care

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“…Lack of consensus guidelines for sedation and analgesia delivery to pediatric intensive care unit patients result in practice variation, and regional attitudes can influence the practices and management of sedation [ 16 , 32 , 37 ]. To achieve optimal sedation in critically ill patients, the use of sedation guidelines, protocols, and algorithms has been advocated by various societies as a means of improving practice and standardizing care [ 19 ].…”

Section: Reviewmentioning

confidence: 99%

“…Inadequate sedation, whether insufficient or excessive, has common side effects, such as an increase in the duration of mechanical ventilation, hospital-acquired infections (in particular ventilator associated pneumonia), hemodynamic instability, unplanned extubation or failure of extubation, development of withdrawal syndromes, and long-term adverse neuropsychological outcomes [ 8 , 16 , 37 ]. Excess sedative medications increase morbidity and mortality [ 18 ].…”

Section: Reviewmentioning

confidence: 99%

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Considerations for pediatric burn sedation and analgesia

Fagin

Palmieri

2017

Burns &Amp; Trauma

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Burn patients experience anxiety and pain in the course of their injury, treatment, and recovery. Hence, treatment of anxiety and pain is paramount after burn injury. Children, in particular, pose challenges in anxiety and pain management due to their unique physiologic, psychologic, and anatomic status. Burn injuries further complicate pain management and sedation as such injuries can have effects on medication response and elimination. Burn injuries further complicate pain management and sedation as such injuries can have effects on medication response and elimination. The purpose of this review is to describe the challenges associated with management of anxiety, pain, and sedation in burned children and to describe the different options for treatment of anxiety and pain in burned children.

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Protocol-directed sedation versus non-protocol-directed sedation in mechanically ventilated intensive care adults and children

Aitken

Bucknall

Kent

et al. 2018

Cochrane Database of Systematic Reviews

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Implementation of a Nurse-Driven Sedation Protocol in a PICU Decreases Daily Doses of Midazolam

Abstract: Implementation of a nurse-driven sedation protocol in a PICU is feasible and safe, allowed a decrease in daily dose of benzodiazepines, and decreased the duration of mechanical ventilation in older patients.

Cited by 37 publications

References 35 publications

Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit

Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit

Considerations for pediatric burn sedation and analgesia

Protocol-directed sedation versus non-protocol-directed sedation in mechanically ventilated intensive care adults and children

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