Outcomes Associated with a Pediatric Intensive Care Unit Sedation Weaning Protocol

Objective: To compare 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 analysis (ITS). Results: There were 49 patients before and 47 patients after protocol implementation. Median opioid wean duration pre-protocol was 10.5 days (IQR: 4.25, 20.75) vs. 9.0 days (IQR: 5.0, 16.75) post-protocol (p=0.66). Median benzodiazepine wean duration was 11.5 days (IQR: 3.0, 19.8) pre-protocol vs. 5.0 days (IQR: 2.0,13.5) post-protocol (p=0.31). Median alpha-agonist wean duration was 7.0 days (IQR: 3.5, 17.0) pre-protocol vs. 3 days (IQR: 1.0, 14.0) post-protocol (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% pre-protocol vs. 9.9% post-protocol, 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.