TOP 48 - Temporal and Contextual Factors Impacting Sedative Exposure

Publication Number: 4751.TOP 48

Ruth A. Riedl, Boston Children's Hospital, Boston, MA, United States; franklin ducatez, Boston Children's Hospital, Brookline, MA, United States; John Kheir, Boston Children's Hospital, BOSTON, MA, United States; Taylor Smith, Harvard Medical School, Boston, MA, United States

Background: Sedation for critically ill children is essential for their comfort and safety in the intensive care unit (ICU). However, higher sedative doses are linked to morbidity in a dose-dependent fashion, and administration varies widely based on clinical and contextual factors. Validated sedation scoring tools and nurse-driven protocols aim to standardize and guide care, but despite these protocols, the indications for administration of as needed (PRN) doses are rarely specified, leading to practice variability. A prior study shows that more PRN sedation doses are given at night. The drivers of this difference are likely multifactorial, such as varying parental presence, ambient noise, delirium, and circadian rhythm. Understanding temporal and contextual differences is critical for efforts to iteratively improve sedation practice and design targeted interventions.

Objective: The objective of this study was to evaluate the usage patterns of PRN sedatives in pediatric patients admitted to a Boston Children’s Hospital ICU. We hypothesized that total PRN sedative doses as well as total dose of sedatives was higher at night compared to during the day, as well as higher within 1 hour of shift change.

Design/Methods: This was a retrospective cohort study of all mechanically ventilated patients admitted to a Boston Children’s Hospital ICU from 2011 to 2024. This study was reviewed by the BCH IRB and determined to be exempt from IRB approval. The primary predictor was day vs night shift, and our primary outcome was number of PRN sedative dose administrations by drug. Data was collected using TWIST, an internal electronic data repository. We have included approximately 150,000 sedative infusion days (75,000 day and night shifts) in our analysis. Day shift was defined as doses administered from 0700-1900. Shift change intervals were defined as doses administered from 0600-0800 and 1800-2000. Number of PRN doses and total dose of sedation medications will be calculated for each shift and shift change period. We will perform a multivariable analysis for associations with increased sedative administration, with inclusion of patient and clinical covariates. Descriptive data will be reported as absolute frequencies and percentages for categorical variables, mean and standard deviation, or median and interquartile range for continuous variables as appropriate.