Study shows new patient care process can decrease risk to children on mechanical ventilation

HERSHEY, PA-Physicians and nurses at Penn State Children's Hospital have developed a process that significantly limits accidental dislodging of the breathing tubes of critically-ill children on ventilators.

"Our first concern for the children in the pediatric intensive care unit is their safety," said Steven E. Lucking, M.D., chief, division of pediatric critical care, Penn State Children's Hospital. "Unplanned dislodging, or extubations, of breathing tubes, can cause serious injury including damage to the airway."

A 10-year study, recently published in Pediatric Critical Care Medicine, showed that a process called the Penn State Children's Hospital Sedation Algorithm, developed by Myra Popernack, R.N. C.C.R.N., pediatric critical care nurse, and Lucking and used by a team of nurses, respiratory therapists and physicians in the pediatric intensive care unit, resulted in a significant decrease in unplanned extubations without increasing the length of stay for patients in the pediatric intensive care unit.

When children are critically ill and need help with breathing, they may be placed on mechanical ventilation, which means that tubes are placed down their throats and machines regulate their respiration. During mechanical ventilation, sedatives are used to keep the children comfortable and to try to prevent the tubes from being deliberately or inadvertently removed by the patient, an event termed, unplanned or accidental extubation.

The Penn State Children's Hospital Sedation Algorithm sets six target behavior goals for ventilated children, such as "awake" or "arouses to light stimulation," and corresponding medication recommendations to achieve those desired behaviors. This goal-setting, based on objective criteria, allows for more consistency in the child's care across staffing shifts and ensures that each child is given adequate medication to ensure appropriate alertness and comfort level while, at the same time, preventing removal

Contact: Valerie Gliem
Penn State

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