Protocolized Sedation Utilizing COMFORT-B Scale versus Non-protocol-directed Sedation in Mechanically Ventilated Children — An Open-label, Randomized Controlled Trial

• Published in: Indian journal of pediatrics 2024-08, Vol.91 (8), p.845-847
• Main Authors: Vallabhaneni, Pujitha, Khera, Daisy, Choudhary, Bharat, Singh, Surjit, Singh, Kuldeep, Didel, Siyaram, Saurabh, Suman, Toteja, Nisha
• Format: Article
• Language: English
• Subjects: Child; Child, Preschool; Clinical Brief; Clinical Protocols; Conscious Sedation - methods; Female; Fentanyl - administration & dosage; Fentanyl - therapeutic use; Gynecology; Humans; Hypnotics and Sedatives - administration & dosage; Infant; Intensive Care Units, Pediatric; Male; Medicine; Medicine & Public Health; Pediatrics; Respiration, Artificial - methods
• ISSN: 0019-5456; 0973-7693; 0973-7693
• DOI: 10.1007/s12098-023-04959-1

This study aimed to determine the effect of protocolized sedation using the COMFORT-B scale on the duration of mechanical ventilation (DMV). Eighty children with anticipated Duration of mechanical ventilation (DMV) >24 h admitted to the Pediatric intensive care unit (PICU) were randomized into one group that received protocolized sedation (PS) using the COMFORT behavioural (COMFORT-B) scale, and another group that received non-protocolized sedation (NPS). The primary outcome was the impact on the DMV. The DMV was significantly lower in PS (PS: 3.5 [3–7] vs. NPS group: 8.5 [4.25–13.75] d; p  = 0.008). The cumulative dose and duration of fentanyl in the PS group was significantly lower (median [IQR]; 120 [62.88–279.12] vs. 320.4 [110.88–851.52] μg/kg; p  = 0.007 and 4 [2.25–7.75] vs. 8 [4–17.5] d; p  = 0.009, respectively). The authors found a decrease in DMV and sedation related adverse events (SRAE) like ventilator associated pneumonia (VAP), accidental extubation, post-extubation stridor and dose and duration of sedative agents with PS.