Protocolized Sedation Provided No Benefit for Ventilated Children with Respiratory Failure

F. Bruder Stapleton, MD reviewing Curley MAQ et al. JAMA 2015 Jan 27.

Use of a standardized sedation protocol did not alter duration of mechanical ventilation or respiratory outcomes in PICU patients.

Despite evidence that standardized sedation protocols improve clinical outcomes in mechanically ventilated adults, sedation practices vary in pediatric intensive care units (PICUs). In a cluster-randomized trial at 31 U.S. PICUs, researchers evaluated outcomes among 2449 mechanically ventilated children (mean age, 4.7 years) randomized to either a standardized sedation titration protocol (using opioids, benzodiazepine, morphine, and midazolam) or routine sedation practices. Pneumonia, bronchiolitis, asthma, and acute respiratory distress accounted for most diagnoses.

The median duration of mechanical ventilation (the primary outcome) did not differ between groups (6.5 days). Similarly, there were no differences between groups in durations of hospital stay, PICU stay, respiratory failure, weaning from the ventilator, or assisted breathing after extubation. Inpatient morality at 28 and 90 days also did not differ between groups. Patients in the protocol group had fewer days of opioid treatment and were more often awake and calm, but they had more episodes of pain and agitation.

Citation(s):

Curley MAQ et al. Protocolized sedation vs usual care in pediatric patients mechanically ventilated for acute respiratory failure: A randomized clinical trial. JAMA 2015 Jan 27; 313:379.