Evaluation of a Pediatric Residents' Procedural Sedation Training Program: Feasibility, Quality, and Complication Rate.

Abstract

Purpose: Procedural sedation (PS) became a crucial component of pediatric care in the late 20th century, necessitating an effective and safe balance. Due to growing demand, it is often performed by pediatric residents, sometimes without formal training. The study aimed to assess the quality and complication rates of a pediatric residents' PS training program.

Methods: This is a retrospective analysis of all pediatric PSs (aged 1 to 18 years) treated by pediatric residents alone or with staff physicians' supervision (Pediatric-Emergency-Care-Specialists or Intensive-Care-Specialists) in our general hospitals' pediatric PS qualification program (November 2017 to July 2021). PS data, including the reason for sedation, course, drugs, and complications, were collected and analyzed. Major complications were defined as the need for positive-pressure ventilation, laryngospasm, cardiopulmonary resuscitation, or unplanned admission.

Results: In all, 3156 PSs were performed, 1386 (43.9%) were conducted by sedation-trained pediatric residents and 1770 (56.1%) with staff physicians' supervision. All the sedations were successful. The percentage of sedations performed by pediatric residents alone increased annually. Midazolam was used in 1652 (52.3%) PSs, ketamine in 1080 (34.2%), and a midazolam-ketamine combination in 943 cases (29.9%). In 3107 (98.4%), PS had no adverse events. Mild adverse events were reported in 50/3156 (1.6%) of the PS with need for airway repositioning (27 cases, 0.9%), intranasal-O2 (13, 0.4%), mild hypoxia (12, 0.4%), suction (9, 0.3%), and intravenous fluids (3, 0.1%). There was only 1 hospital admission due to prolonged recovery. By multivariate analysis, slightly higher odds ratio (OR) for mild adverse event was found among patients with any chronic disease (OR=2.48, 95% CI: 1.20-5.14, P=0.014), and PS performed by pediatric residents alone versus pediatric residents guided by staff physicians (OR=2.26, 95% CI: 1.23-4.13, P=0.008).

Conclusions: These findings highlight the feasibility of a PS service led by trained pediatric residents, as confirmed by the high PS success rate and 98.4% rate of no adverse reactions.