(1346) Reduction of Midazolam Usage After the PICU Liberation Bundle Implementation

Introduction: Delirium is a prevalent issue among pediatric intensive care unit (PICU) patients, affecting up to three out of five children. Effective management involves systematic monitoring for delirium, pain, agitation, and withdrawal through interdisciplinary care models. The A-F bundle has been shown to mitigate delirium prevalence in PICU settings. This study aimed to assess the impact of implementing the PICU Liberation bundle on midazolam use in a single PICU.

Methods: The PICU Liberation bundle was introduced from August 2023 to December 2023. Comparison of midazolam use was made between the first semesters of 2023 and 2024 to evaluate effectiveness.

Results: In the first semester of 2023, 2933mg of midazolam was administered over 652 ventilation days, averaging 4.5mg per ventilation day. In contrast, during the first semester of 2024, 2268mg of midazolam was used, averaging 3.2mg per ventilation day, marking a 29% reduction in midazolam usage. Due to the lack of delirium screening before bundle implementation, comparisons in delirium prevalence between the two periods were not feasible.

Conclusions: The findings of this study indicate that the implementation of the PICU Liberation bundle significantly decreased midazolam use in this PICU. These results underscore the bundle’s potential to optimize care practices and improve outcomes in PICU settings.