Decreasing unplanned extubations: utilization of the Penn State Children's Hospital Sedation Algorithm

To determine whether institution of a standardized algorithm of goal-directed sedation impacted the incidence of unplanned extubations in critically ill pediatric patients. Prospective, observational study with historical controls. Pediatric intensive care unit (PICU) in a tertiary care university-based children's hospital. All mechanically ventilated children admitted to the PICU during a 10-yr period. After examining the data pertaining to unplanned extubations, the Penn State Children's Hospital Sedation Algorithm (PSCHSA) was instituted as an absolute requirement for all mechanically ventilated children. Physician orders for the goal sedation level and the appropriate medications to achieve that goal were obligatory for every ventilated patient. Data were then collected for 5 yrs after institution of the PSCHSA. Before utilization of the PSCHSA, unplanned extubation rates ranged between 0.44 and 0.63 per 100 intubated patient days. In the 4 yrs after mandatory use of the PSCHSA for management of all ventilated patients, unplanned extubation rates were between 0 and 0.19 per 100 intubated patient days, demonstrating a significant decrease (p