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Author Notes:

pradip.kamat@choa.org Tel.: +404-277-8010

Conceptualization, P.P.K., C.T. and N.S.; Data curation, L.D.L. and W.M.; Formal analysis, I.D. and S.G.; Methodology, C.T., M.D., I.D. and S.G.; Writing—original draft, P.P.K., M.D. and N.S.; Writing—review and editing, C.T., L.D.L. and W.M.

All authors have read and agreed to the published version of the manuscript.

We thank the Emory University and Children’s Healthcare of Atlanta Biostatistics Core for their help with statistical analysis.

The authors declare no conflict of interest.


Research Funding:

This research received no external funding.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Pediatrics
  • analgosedation
  • benzodiazepines
  • delirium
  • opiates
  • sedation
  • withdrawal
  • protocol

"Difficult to Sedate": Successful Implementation of a Benzodiazepine-Sparing Analgosedation-Protocol in Mechanically Ventilated Children


Journal Title:



Volume 8, Number 5


Type of Work:

Article | Final Publisher PDF


We sought to evaluate the success rate of a benzodiazepine-sparing analgosedation protocol (ASP) in mechanically ventilated children and determine the effect of compliance with ASP on in-hospital outcome measures. In this single center study from a quaternary pediatric intensive care unit, our objective was to evaluate the ASP protocol, which included opiate and dexmedetomidine infusions and was used as first-line sedation for all intubated patients. In this study we included 424 patients. Sixty-nine percent (n = 293) were successfully sedated with the ASP. Thirty-one percent (n = 131) deviated from the ASP and received benzodiazepine infusions. Children sedated with the ASP had decrease in opiate withdrawal (OR 0.16, 0.08–0.32), decreased duration of mechanical ventilation (adjusted mean duration 1.81 vs. 3.39 days, p = 0.018), and decreased PICU length of stay (adjusted mean 3.15 vs. 4.7 days, p = 0.011), when compared to the cohort of children who received continuous benzodiazepine infusions. Using ASP, we report that 69% of mechanically ventilated children were successfully managed with no requirement for continuous benzodiazepine infusions. The 69% who were successfully managed with ASP included infants, severely ill patients, and children with chromosomal disorders and developmental disabilities. Use of ASP was associated with decreased need for methadone use, decreased duration of mechanical ventilation, and decreased ICU and hospital length of stay.

Copyright information:

© 2021 by the authors.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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