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Implementation of a Nurse-Driven Sedation Protocol in a PICU Decreases Daily Doses of Midazolam

Gaillard-Le Roux, Bénédicte MD1,2; Liet, Jean-Michel MD, PhD1,2; Bourgoin, Pierre MD1,2; Legrand, Arnaud MSc2; Roze, Jean-Christophe MD, PhD1,2; Joram, Nicolas MD1,2

Pediatric Critical Care Medicine: January 2017 - Volume 18 - Issue 1 - p e9-e17
doi: 10.1097/PCC.0000000000000998
Online Clinical Investigations

Objectives: 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.

Design: A single-center prospective before and after study was conducted from October 2010 to December 2013.

Setting: Twelve-bed surgical and medical PICU of the university-affiliated hospital in Nantes, France.

Patients: 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.

Interventions: During the first study phase, no protocol was used. During the second phase, patients were sedated according to a nurse-driven protocol.

Measurements and Main Results: 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).

Conclusions: 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.

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.

The authors have disclosed that they do not have any potential conflicts of interest.

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