{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T06:07:07Z","timestamp":1777010827172,"version":"3.51.4"},"reference-count":35,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2022,7,12]],"date-time":"2022-07-12T00:00:00Z","timestamp":1657584000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Recent studies reported that children on mechanical ventilation who were managed with an analgosedation approach and standardized extubation readiness testing experienced better outcomes, including decreased delirium and invasive mechanical ventilation duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This was a quality improvement project in a 24-bed pediatric ICU within a single center, including subjects \u2264 18 years old who required invasive mechanical ventilation via an oral or nasal endotracheal tube. The aim was to decrease the invasive mechanical ventilation duration for all the subjects by 25% within 9 months through the development and implementation of bundled benzodiazepine-sparing analgosedation and extubation readiness testing clinical pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      In the pre-implementation cohort, there were 274 encounters, with 253 (92.3%) that met inclusion for ending in an extubation attempt. In the implementation cohort, there were 367 encounters with 332 (90.5%) that ended in an extubation attempt. The mean invasive mechanical ventilation duration decreased by 23% (Pre 3.95 d vs Post 3.1 d;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .039) after the implementation without a change in the mean pediatric ICU length of stay (Pre 7.5 d vs Post 6.5 d;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .42). No difference in unplanned extubation (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; .99) or extubation failure rates (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .67) were demonstrated. Sedation levels as evaluated by the mean State Behavioral Scale were similar (Pre \u22121.0 vs Post \u22121.1;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .09). The median total benzodiazepine dose administered decreased by 75% (Pre 0.4 vs Post 0.1 mg\/kg\/ventilated day;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). No difference in narcotic withdrawal (Pre 17.8% vs Post 16.4%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .65) or with delirium treatment (Pre 5.5% vs Post 8.7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .14) was demonstrated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>A multidisciplinary, bundled benzodiazepine-sparing analgosedation and extubation readiness testing approach resulted in a reduction in mechanical ventilation duration and benzodiazepine exposure without impacting key balancing measures. External validity needs to be evaluated in similar centers and consensus on best practices developed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.09942","type":"journal-article","created":{"date-parts":[[2022,7,12]],"date-time":"2022-07-12T10:00:26Z","timestamp":1657620026000},"page":"1385-1395","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Pediatric Ventilation Liberation: Bundled Extubation Readiness and Analgosedation Pathways Decrease Mechanical Ventilation Duration and Benzodiazepine Exposure"],"prefix":"10.1177","volume":"67","author":[{"given":"Jeremy M","family":"Loberger","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen C","family":"Waddell","sequence":"additional","affiliation":[{"name":"Department of Nursing Services, Children\u2019s of Alabama, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priya","family":"Prabhakaran","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan M","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy, Children\u2019s of Alabama, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maggie V","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Department of Nursing Services, Children\u2019s of Alabama, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leah A","family":"Bittles","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy M","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy, Children\u2019s of Alabama, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon E","family":"O\u2019Sheal","sequence":"additional","affiliation":[{"name":"Department of Nursing Services, Children\u2019s of Alabama, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea W","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Department of Nursing Services, Children\u2019s of Alabama, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christy L","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy, Children\u2019s of Alabama, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura H","family":"Daniel","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Children\u2019s of Alabama, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy M","family":"Tofil","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William C","family":"Sasser","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert P","family":"Richter","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chrystal L","family":"Rutledge","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,7,12]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-0207"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199202000-00008"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001485"},{"issue":"1","key":"e_1_3_2_5_2","first-page":"e2062","article-title":"The effect of daily sedation-weaning application on morbidity and mortality in intensive care unit patients","volume":"10","author":"Kayir S","year":"2018","unstructured":"Kayir S, , Ulusoy H, , Dogan G. 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