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Article

“Difficult to Sedate”: Successful Implementation of a Benzodiazepine-Sparing Analgosedation-Protocol in Mechanically Ventilated Children

1
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
2
Division of Pediatric Critical Care Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
3
Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065, USA
4
Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
5
Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
6
Georgia Institute of Technology, Atlanta, GA 30332, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Marco Carotenuto
Received: 17 March 2021 / Revised: 26 April 2021 / Accepted: 27 April 2021 / Published: 28 April 2021
(This article belongs to the Special Issue Advances in Pediatric Critical Care)
We sought to evaluate the success rate of a benzodiazepine-sparing analgosedation protocol (ASP) in mechanically ventilated children and determine the effect of compliance with ASP on in-hospital outcome measures. In this single center study from a quaternary pediatric intensive care unit, our objective was to evaluate the ASP protocol, which included opiate and dexmedetomidine infusions and was used as first-line sedation for all intubated patients. In this study we included 424 patients. Sixty-nine percent (n = 293) were successfully sedated with the ASP. Thirty-one percent (n = 131) deviated from the ASP and received benzodiazepine infusions. Children sedated with the ASP had decrease in opiate withdrawal (OR 0.16, 0.08–0.32), decreased duration of mechanical ventilation (adjusted mean duration 1.81 vs. 3.39 days, p = 0.018), and decreased PICU length of stay (adjusted mean 3.15 vs. 4.7 days, p = 0.011), when compared to the cohort of children who received continuous benzodiazepine infusions. Using ASP, we report that 69% of mechanically ventilated children were successfully managed with no requirement for continuous benzodiazepine infusions. The 69% who were successfully managed with ASP included infants, severely ill patients, and children with chromosomal disorders and developmental disabilities. Use of ASP was associated with decreased need for methadone use, decreased duration of mechanical ventilation, and decreased ICU and hospital length of stay. View Full-Text
Keywords: analgosedation; benzodiazepines; delirium; opiates; sedation; withdrawal; protocol analgosedation; benzodiazepines; delirium; opiates; sedation; withdrawal; protocol
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MDPI and ACS Style

Shildt, N.; Traube, C.; Dealmeida, M.; Dave, I.; Gillespie, S.; Moore, W.; Long, L.D.; Kamat, P.P. “Difficult to Sedate”: Successful Implementation of a Benzodiazepine-Sparing Analgosedation-Protocol in Mechanically Ventilated Children. Children 2021, 8, 348. https://0-doi-org.brum.beds.ac.uk/10.3390/children8050348

AMA Style

Shildt N, Traube C, Dealmeida M, Dave I, Gillespie S, Moore W, Long LD, Kamat PP. “Difficult to Sedate”: Successful Implementation of a Benzodiazepine-Sparing Analgosedation-Protocol in Mechanically Ventilated Children. Children. 2021; 8(5):348. https://0-doi-org.brum.beds.ac.uk/10.3390/children8050348

Chicago/Turabian Style

Shildt, Nataly, Chani Traube, Mary Dealmeida, Ishaan Dave, Scott Gillespie, Whitney Moore, Lillian D. Long, and Pradip P. Kamat 2021. "“Difficult to Sedate”: Successful Implementation of a Benzodiazepine-Sparing Analgosedation-Protocol in Mechanically Ventilated Children" Children 8, no. 5: 348. https://0-doi-org.brum.beds.ac.uk/10.3390/children8050348

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