Targeted Levels of Sedation in the Critically Ill Child

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Authors
Hale, Casie
Issue Date
2024-05-09
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post-intensive care syndrome (PICS) , pediatrics , critical illness , sedation , targeted level of sedation , RASS , multidisciplinary rounds checklist
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Abstract
Purpose: The purpose of this quality improvement project was to educate Pediatric Intensive Care Unit (PICU) staff about post-intensive care syndrome (PICS) and to utilize the Richmond Agitation Sedation Scale (RASS) score to assess, monitor, and adjust sedation to pre-determined targeted levels to minimize the risk of over- and undersedation of all mechanically ventilated PICU patients. Background: PICS is a newly recognized condition which occurs in patients following an intensive care stay. This condition exhibits a wide spectrum of physical, psychological, and cognitive symptoms. The Society of Critical Care Medicine (SCCM) provides guidelines to reduce the risk of PICS through their ICU Liberation (A-F) Bundle that promotes strategies to reduce patient time spent on mechanical ventilation and enhance efforts to maintain appropriate levels of sedation. Sample/Setting: All day and night shift PICU RNs, regardless of full-time, part-time or per diem status, PICU residents, and pediatric intensivists. The intended target population was pediatric patients that were mechanically ventilated in the PICU. The project was implemented in a 12- bed PICU at a Midwestern children’s hospital. Methods: A coordinated education and targeted level of sedation protocol was implemented and evaluated with descriptive statistics. All PICU RNs received PICS education. The nurse driven, goal-directed, sedation protocol was updated to include a targeted level of sedation. A multidisciplinary rounds (MDR) checklist guided discussions for determining individualized targeted levels of sedation. The MDR was utilized during daily rounds. Results: A total of 18 patients were included which represented 114 sedation days. Out of the total number of sedation days, there were 77 days in which a targeted RASS score was prescribed and located in the chart (68%). Of the 77 ordered RASS scores, 40 (52%) met the targeted level. Conclusion: The MDR checklist appears to be a reasonable strategy to promote prescription of targeted sedation levels for mechanically ventilated PICU patients. The nurse driven sedation protocols demonstrated some success (52%) in achieving targeted levels of sedation suggesting that further education to promote uniform sedation practices should be considered.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University
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