Plan Fails to Cut Ventilator Use in Critically Ill Children

PHOENIX — A sedation protocol designed to improve outcomes in critically ill children did not reduce the duration of mechanical ventilation, according to a large multicenter trial.

"Among children undergoing mechanical ventilation for acute respiratory failure, the use of a nurse-implemented, goal-directed sedation protocol, compared with usual care, did not reduce the duration of mechanical ventilation," researchers report.

Although the protocol didn't reduce time on a mechanical ventilator — the study's primary end point — some of the secondary end points were met, said Martha Curley, RN, PhD, from the University of Pennsylvania in Philadelphia.

"We had some pretty exciting secondary findings. For example, the protocol provided our young patients with a different, and I would say better, sedation experience," she told Medscape Medical News.

"This is a landmark study that greatly informs our understanding of sedation in the pediatric intensive care unit," said Alexandre Rotta, MD, from University Hospitals Rainbow Babies & Children's Hospital in Cleveland.

The study results were published online in JAMA to coincide with their presentation here at the Society of Critical Care Medicine 44th Critical Care Congress.

 

This is a landmark study that greatly informs our understanding of sedation in the pediatric intensive care unit.

 

Sedation therapy, although necessary for critical care patients being supported by mechanical ventilation, has some disadvantages. In particular, opioids and benzodiazepines have the potential to hamper neurologic assessments and prolong mechanical ventilation.

With the protocol, "the patients received fewer days of opioid exposure and exposure to fewer sedative classes, which is important in young patients who are still undergoing brain development," Dr. Curley explained. In addition, patients were in a more awake state when they were intubated.

Dr Martha Curley

In their study, Dr. Curley and her colleagues assessed mechanical ventilation at 31 PICUs in the United States. At the 17 intervention sites, 1225 children were managed with the sedation protocol; at the 14 control sites, 1224 children were managed with usual care.