Reducing Deep Sedation and Benzodiazepine Use in Mechanically Ventilated Patients During Critical Care Transport: A Quality Improvement Initiative

•A reduction in rates of deep sedation can be achieved safely without adverse events.•Quality improvement projects undertaken by a multidisciplinary team can reduce sedation exposure in transport.•Compared with previous baseline data, the rate of benzodiazepine use has decreased and was not impacted further by this initiative.•Opportunities exist to further reduce the frequency of unindicated deep sedation and the use of benzodiazepines in transport. Deep sedation of mechanically ventilated patients is associated with poorer outcomes, including longer hospital length of stay and more ventilator days. In contrast, light sedation is associated with decreased hospital and intensive care unit length of stay, lower ventilator days, and decreased mortality. This study sought to decrease the use of unindicated deep sedation and benzodiazepine use in mechanically ventilated patients during critical care transport. Previous work identified > 90% of intubated, nonparalyzed patients were deeply sedated in this critical care transport system. This study was conducted at a critical care transport service affiliated with a rural academic medical center. Chart review of all mechanically ventilated adults transported between January and November 2023 with no indication for deep sedation was performed. Improvement initiatives were implemented using Plan-Do-Study-Act cycles and included transport crew education, guideline revision, and enhanced performance feedback. A 25% reduction in the proportion of deeply sedated patients was achieved. Deep sedation is not universally indicated in critical care transport of mechanically ventilated patients. This quality improvement initiative achieved its main aim of reducing the proportion of deeply sedated patients by 25% with the implementation of 3 Plan-Do-Study-Act cycles.