title: Decreasing unplanned extubations: utilization of the Penn State Children's Hospital Sedation Algorithm.
abstract: OBJECTIVE
  To determine whether institution of a standardized algorithm of goal-directed sedation impacted the incidence of unplanned extubations in critically ill pediatric patients.
  
  
  METHODS
  Prospective, observational study with historical controls.
  
  
  METHODS
  Pediatric intensive care unit (PICU) in a tertiary care university-based children's hospital.
  
  
  METHODS
  All mechanically ventilated children admitted to the PICU during a 10-yr period.
  
  
  METHODS
  After examining the data pertaining to unplanned extubations, the Penn State Children's Hospital Sedation Algorithm (PSCHSA) was instituted as an absolute requirement for all mechanically ventilated children. Physician orders for the goal sedation level and the appropriate medications to achieve that goal were obligatory for every ventilated patient. Data were then collected for 5 yrs after institution of the PSCHSA.
  
  
  RESULTS
  Before utilization of the PSCHSA, unplanned extubation rates ranged between 0.44 and 0.63 per 100 intubated patient days. In the 4 yrs after mandatory use of the PSCHSA for management of all ventilated patients, unplanned extubation rates were between 0 and 0.19 per 100 intubated patient days, demonstrating a significant decrease (p<.001). Throughout the entire study period, no changes were made in the model of patient care that would alter the rate of unplanned extubations. Despite a higher percentage of PICU patients that were intubated, length of stay in the PICU did not increase, suggesting that oversedation did not led to increased ventilator days.
  
  
  CONCLUSIONS
  Utilization of the PSCHSA resulted in a decreased number of unplanned extubations without increasing the length of PICU stay. Implementation of the PSCHSA is needed in other PICUs to validate these findings.
authors.affiliation: Pediatric Intensive Care Unit, Department of Nursing, Penn State Children's Hospital and The Pennsylvania State University College of Medicine, Hershey, PA, USA.
authors.forename: Myra L
authors.initials: ML
authors.lastname: Popernack
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Thomas
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lucking
mesh_terms: D000465:Algorithms; D002648:Child; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000451:nursing / Q000706:statistics & numerical data; D010414:Pennsylvania; D011446:Prospective Studies; D012308:Risk Management / Q000379:methods*
chemical_list: D006993:Hypnotics and Sedatives