title: Implementation of a Nurse-Driven Sedation Protocol in a PICU Decreases Daily Doses of Midazolam.
abstract: To evaluate the impact of a nurse-driven sedation protocol on the length of mechanical ventilation, total daily doses of sedatives, and complications of sedation.
  
  
  
  A single-center prospective before and after study was conducted from October 2010 to December 2013.
  
  
  
  Twelve-bed surgical and medical PICU of the university-affiliated hospital in Nantes, France.
  
  
  
  A total of 235 patients, between 28 days and 18 years old, requiring mechanical ventilation for at least 24 hours were included in the study; data from 194 patients were analyzed.
  
  
  
  During the first study phase, no protocol was used. During the second phase, patients were sedated according to a nurse-driven protocol.
  
  
  
  In the whole population, the length of mechanical ventilation did not differ between protocol and control groups (protocol, 4 [3-8] vs control, 5 [3-7.5]; p = 0.44). Analyzing age subgroups, the length of mechanical ventilation was significantly shorter in the protocol group than in the control group in children older than 12 months (4 [3-8] vs 5 [2.75-11.25] d; p = 0.04). Daily dose of midazolam decreased during the protocol phase compared with the control phase (1 [0.56-1.8] and 1.2 [0.85-2.4] mg/kg/d, respectively; p = 0.02). No differences were shown regarding other daily dose of drugs. In the control group, 68% of children had more than 20% of COMFORT-behavior scale assessment under the target (oversedation) versus 59% in the protocol group (p = 0.139).
  
  
  
  Implementation of a nurse-driven sedation protocol in a PICU is feasible and safe, allowed a decrease in daily dose of benzodiazepines, and decreased the duration of mechanical ventilation in older patients.
authors: 1Department of Pediatric Intensive Care, Nantes University Hospital, Nantes, France.2Department of Clinical Investigation, Women's, Children's and Adolescent's Hospital, CIC INSERM 1413, Nantes University Hospital, Nantes, France.
authors: Bénédicte
authors: B
authors: Gaillard-Le Roux
authors: Jean-Michel
authors: JM
authors: Liet
authors: Pierre
authors: P
authors: Bourgoin
authors: Arnaud
authors: A
authors: Legrand
authors: Jean-Christophe
authors: JC
authors: Roze
authors: Nicolas
authors: N
authors: Joram
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D016292:Procedural Sedation / Q000379:methods / Q000451:nursing*; D054810:Deep Sedation / Q000379:methods / Q000451:nursing*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012121:Respiration, Artificial
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam