(686) How Sleepy Is Too Sleepy? Sedation Optimization in Critically Ill Pediatrics Patients

Tuesday, January 23, 2024

8:45 AM – 9:45 AM MT

Location: Connections Central - RST 14

First Author(s)

MM

Marwa Mansour

n/a
Houston, Texas

Co-Author(s)

Maryam Gilpatrick

Baylor College of Medicine at Texas Childrens Hospital
Houston, Texas
JA

Jordan Ashcraft, MD

Clinical Fellow
Baylor College of Medicine - Pediatric Critical Care, United States
ES

Ellie Souganidis, MD

Clinical Fellow
Baylor College of Medicine - Pediatric Critical Care, United States
Amy Dutko, MD (she/her/hers)

Clinical Fellow
Baylor College of Medicine - Pediatric Critical Care
Houston, Texas, United States
MI

Maki Ishizuka, MD

Baylor College of Medicine Texas Children's Hospital
Houston, Texas
AC

Anjali Chadayammuri, MD

Clinical Fellow
Baylor College of Medicine - Pediatric Critical Care, United States
PP

Pamela Petersen, MD

Assistant Professor
Baylor College of Medicine - Pediatric Critical Care, United States

Introduction: Analgesia based multimodal sedative approaches are the foundation for comfort in the pediatric intensive care unit (PICU) population. High-dose, long-term, and continuous intravenous sedation is associated with prolonged invasive mechanical ventilation (IMV) and iatrogenic withdrawal syndrome (IWS). Implementing sedation protocols has been shown to significantly reduce IMV duration and can improve patient outcomes.
The PANDEM* guidelines recommend protocolized sedation in critically ill pediatric patients requiring IMV, including assigning a target sedation depth using a validated assessment tool, such as the State Behavior Scale (SBS).

Methods: This quality improvement initiative aimed to improve the percentage of SBS goal orders for intubated patients in the PICU. We performed monthly analyses using data collected from our Electronic Data Warehouse. The first PDSA cycle consisted of education on sedation protocols and SBS goals to nursing leadership, advanced practice practitioners (APPs), medical trainees, and attending physicians through lectures and emails. The second PDSA cycle added the SBS goal to the safety checklist in the daily progress note template.

Results: Our cohort consisted of 862 patient encounters. One month prior to the first PDSA cycle, 30% of intubated patients had SBS goals ordered. Following the first PDSA cycle, 38% had SBS goals ordered. After the second PDSA cycle, the percentage of SBS goals ordered peaked at 42%, however this improvement was not sustained in the following months.

Conclusions: Educating clinical team members on SBS goals and sedation protocols as well as utilizing a safety checklist has the potential to increase the percentage of SBS goal orders placed, however the effects were poorly sustained. Next steps will include implementing a hard stop SBS goal order in our PICU sedation order set and reinforcement of education to the involved team members.

* The guidelines for Pain, Agitation, Neuromuscular Blockade, Delirium and Early Mobility in Critically Ill Pediatric Patients