Outcomes Associated with a Pediatric Intensive Care Unit Sedation Weaning Protocol

Abstract Objective  This article compares patient outcomes before and after implementation of a risk stratified pediatric sedation weaning protocol. Methods  This observational cohort study, in a 30-bed tertiary care pediatric intensive care unit (PICU), included patients requiring opioid, benzodiazepine, and/or dexmedetomidine infusions. Outcomes (duration of wean, PICU length of stay [LOS], and Withdrawal Assessment Tool [WAT-1] scores) were collected by retrospective chart review for 12 months before and after protocol implementation. The influence of the protocol was assessed using an interrupted time series (ITS) analysis. Results  There were 49 patients before and 47 patients after protocol implementation. Median opioid wean duration preprotocol was 10.5 days (interquartile range [IQR]: 4.25, 20.75) versus 9.0 days (IQR: 5.0, 16.75) postprotocol ( p  = 0.66). Median benzodiazepine wean duration was 11.5 days (IQR: 3.0, 19.8) preprotocol versus 5.0 days (IQR: 2.0, 13.5) postprotocol ( p  = 0.31). Median alpha-agonist wean duration was 7.0 days (IQR: 3.5, 17.0) preprotocol versus 3 days (IQR: 1.0, 14.0) postprotocol ( p  = 0.03). The ITS indicated a reduction in opioid wean by 6.7 days ( p  = 0.35), a reduction in benzodiazepine wean by 13.4 days ( p  = 0.12), and a reduction in alpha-agonist wean by 12.9 days ( p  = 0.06). WAT-1 scores > 3 (12.6% preprotocol vs. 9.9% postprotocol, p  = 0.569) and PICU LOS (16.0 days [IQR: 11.0, 26.0] vs. 17.0 days [IQR: 11.0, 26.5], p  = 0.796) did not differ between groups. Conclusion  Implementation of a risk stratified sedation weaning protocol in the PICU was associated with a significant reduction in alpha-agonist wean duration without a significant increase in withdrawal symptoms.