(1343) Protocolized Sedation and Analgesia Weaning in Mechanically Ventilated PICU Patients: A QI Project

Introduction: Sedation use is an independent predictor of prolonged mechanical ventilation, ICU stay, and hospital length of stay (LOS). Protocolized sedation reduces duration of continuous sedative infusions and total sedation exposure. We hypothesize that non-protocolized conversion from intravenous (IV) to enteral (PO) formulation and subsequent weaning increases LOS, total dose exposure to opiates and benzodiazepines, and duration of IV formulation.

Methods: The global aim is to reduce variability in sedation and weaning practices. Our smart aim is to reduce duration of IV sedation in mechanically ventilated patients by 10% within six months of intervention. We created an electronic health record (EHR)-based IV to PO calculator to facilitate correct and consistent dosing. Provider impressions and clinical impact were evaluated with a pre-implementation survey with subsequent surveys to follow each plan-do-study-act (PDSA) cycle. Baseline data were gathered via retrospective chart review for patients aged 0 to 18 years and mechanically ventilated for 5 or more days during the months of January and July from 2018 through 2022. The same data will be collected with future PDSA cycles.

Results: Baseline data were entered into a de-identified REDCap database and analyzed with QI Macros. Sixty-seven patients met inclusion criteria. Median days of mechanical ventilation was 10 days (IQR: 7-16 days) with ICU LOS 10-24 days (median: 16.8 days). Fifty-nine (88%) were exposed to a continuous opiate infusion, with a median of 9.1 days (IQR: 6.3-13.3 days). Of those, 37 (63%) were transitioned to an intermittent opiate with median weaning phase of 13.1 days (IQR: 7.9-16.5 days). Thirty-one (46%) received continuous benzodiazepine infusion with median of 5.8 days (IQR: 3.3-10.1 days); 16 (52%) transitioned to an intermittent benzodiazepine with a median weaning phase of 13.2 days (IQR: 7.9-16.9).

Conclusions: Baseline metrics data reflect a broad range of weaning duration suggesting inconsistent weaning practices. Our EHR tool will create consistency, reduce duration, and decrease ICU LOS and ventilation days. We anticipate completion and roll out of our calculator during Q3 of 2024 with completion of 2 PDSA cycles by the end of 2024. Data analysis and post-implementation survey analysis will be completed thereafter.