King Caitlin E, Wood Danielle N, Koo Jeannie, Cutler Austin B, Vesel Travis P
Department of Pediatrics, Duke University, Durham, NC.
Duke Clinical Research Institute, Durham, NC.
Pediatr Crit Care Med. 2023 Jul 1;24(7):e332-e341. doi: 10.1097/PCC.0000000000003233. Epub 2023 Apr 12.
Sedation and pain medications are necessary in the management of postoperative pediatric cardiac patients. Prolonged exposure to these medications can lead to negative side effects including withdrawal. We hypothesized that standardized weaning guidelines would decrease exposure to sedation medications and decrease withdrawal symptoms. The primary aim was to decrease average days of methadone exposure to within goal for moderate- and high-risk patients within 6 months.
Quality improvement methods were used to standardize sedation medication weaning in a pediatric cardiac ICU.
This study took place at Duke Children's Hospital Pediatric Cardiac ICU in Durham, North Carolina from January 1, 2020, to December 31, 2021.
Children less than 12 months old admitted to the pediatric cardiac ICU who underwent cardiac surgery.
Sedation weaning guidelines were implemented over the course of 12 months. Data were tracked every 6 months and compared with the 12 months pre-intervention. Patients were stratified into low, moderate, and high risk withdrawal categories based on duration of opioid infusion exposure.
Total sample size was 94 patients in the moderate and high risk categories. Process measures included documentation of Withdrawal Assessment Tool scores and appropriate methadone prescription in patients which increased to 100% post-intervention. For outcome measures, we observed decreased dexmedetomidine infusion duration, decreased methadone wean duration, decreased frequency of elevated Withdrawal Assessment Tool scores, and decreased hospital length of stay post-intervention. For the primary aim, methadone wean duration consistently decreased after each study period. Our intervention did not adversely impact balancing measures.
A quality improvement initiative to standardize sedation weaning in a Pediatric Cardiac ICU was successfully implemented and was correlated with decreased duration of sedation medications, decreased withdrawal scores, and decreased length of stay.
镇静和止痛药物在小儿心脏术后患者的管理中是必要的。长时间使用这些药物会导致包括戒断反应在内的负面副作用。我们假设标准化的撤药指南将减少镇静药物的使用，并减少戒断症状。主要目标是在6个月内将中度和高风险患者的美沙酮平均使用天数降至目标范围内。
采用质量改进方法对小儿心脏重症监护病房的镇静药物撤药进行标准化。
本研究于2020年1月1日至2021年12月31日在北卡罗来纳州达勒姆的杜克儿童医院小儿心脏重症监护病房进行。
入住小儿心脏重症监护病房并接受心脏手术的12个月以下儿童。
在12个月的时间里实施镇静撤药指南。每6个月跟踪一次数据，并与干预前的12个月进行比较。根据阿片类药物输注暴露时间将患者分为低、中、高风险戒断类别。
中度和高风险类别的总样本量为94例患者。过程指标包括戒断评估工具评分的记录以及患者适当的美沙酮处方，干预后增加到100%。对于结果指标，我们观察到干预后右美托咪定输注时间缩短、美沙酮撤药时间缩短、戒断评估工具评分升高的频率降低以及住院时间缩短。对于主要目标，每个研究期后美沙酮撤药时间持续缩短。我们的干预对平衡指标没有不利影响。
一项在小儿心脏重症监护病房标准化镇静撤药的质量改进计划成功实施，并与镇静药物使用时间缩短、戒断评分降低和住院时间缩短相关。
