Children undergoing mechanical ventilation has been shown to do better when their care is guided by an analgosedation strategy and standardized extubation readiness testing, according to recent research. Patients less than or equal to 18 years old who required invasive mechanical breathing by an oral or nasal endotracheal tube were included in this quality improvement initiative conducted in a 24-bed pediatric ICU at a single center. 

The study aimed to establish and execute bundled benzodiazepine-sparing analgosedation and extubation readiness testing clinical pathways to reduce the duration of invasive mechanical ventilation for all individuals by 25% within 9 months. 

There were 274 contacts in the pre-implementation cohort, and 253 (92.3%) were included because they ended in an extubation attempt. There were 367 interactions in the implementation cohort, with 332 (90.5%) leading to an extubation attempt. Without affecting the average length of stay in the pediatric intensive care unit (Pre 7.5 d vs. Post 6.5 d; P =.42), the average length of time a patient spent on invasive mechanical ventilation dropped by 23% after adoption (Pre 3.95 d vs. Post 3.1 d; P =.039). There was no statistically significant difference in the rates of unplanned extubation (P>.99) or extubation failure (P =.67). The mean State Behavioral Scale score for sedation before and after treatment was quite close (Pre 1.0 vs. Post 1.1; P =.09). Before treatment, the median total benzodiazepine dose was 0.4 mg/kg/ventilated day, and after treatment, it was 0.1 mg/kg/ventilated day (P<.001). Pretreatment rates of narcotic withdrawal (17.8%) and posttreatment rates of delirium (8.5%) were not significantly different (P =.65 and P =.14, respectively). 

Mechanical breathing time and benzodiazepine exposure were reduced thanks to a multidisciplinary, bundled benzodiazepine-sparing analgosedation and extubation readiness testing method that did not negatively affect essential balancing parameters. Consensus on best practices must be reached, and external validity must be assessed in comparable centers.