Sedation Protocol Not Shown to Reduce Duration of Ventilation in PICU
(HealthDay News) — For children in pediatric intensive care units (PICUs) mechanically ventilated for acute respiratory failure, the use of a sedation protocol does not reduce the duration of mechanical ventilation, according to a study published in the January 27 issue of the Journal of the American Medical Association.
Martha A.Q. Curley, RN, PhD, from the University of Pennsylvania in Philadelphia, and colleagues conducted a cluster randomized trial in 31 U.S. PICUs with 2,449 children mechanically ventilated for acute respiratory failure. A protocol that included targeted sedation, arousal assessments, extubation readiness testing, sedation adjustment every eight hours, and sedation weaning was used in 17 intervention PICUs (1,225 children), while 14 control PICUs (1,224 children) managed sedation per usual care.
The researchers found that there was no between-group difference in the duration of mechanical ventilation (median, 6.5 days for both groups). There were no significant between-group differences in sedation-related adverse events including inadequate pain and sedation management, clinically significant iatrogenic withdrawal, and unplanned endotracheal tube/invasive line removal. More postextubation stridor and fewer stage 2 or worse immobility-related pressure ulcers were seen for intervention patients (P=0.03 and 0.001, respectively).
"Among children undergoing mechanical ventilation for acute respiratory failure, the use of a sedation protocol compared with usual care did not reduce the duration of mechanical ventilation," the authors write.
Two authors disclosed financial ties to the pharmaceutical and medical technology industries.