• Amy Donnellan, Jaclyn Sawyer, Anne Peach, Sandra Staveski, David P Nelson, and J Nick Pratap.
• Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
• Pediatr Crit Care Me. 2019 Apr 1; 20 (4): 340-349.

ObjectivesTo evaluate the effect of implementation of a comfort algorithm on infusion rates of opioids and benzodiazepines in postneonatal postoperative pediatric cardiac surgery patients.DesignA quality improvement project, using statistical process control methodology.SettingTwenty-five-bed tertiary care pediatric cardiac ICU in an urban academic Children's hospital.PatientsPostoperative pediatric cardiac surgery patients.InterventionsImplementation of a guided comfort medication algorithm which consisted of key components; a low dose opioid continuous infusion, judicious use of frequent as needed opioids, initiation of dexmedetomidine infusion postoperatively, and minimal use of benzodiazepines.Measurements And Main ResultsAmong the baseline group admitted over the 18 month period prior to comfort algorithm implementation, 58 of 116 intubated patients (50%) received a continuous opioid infusion, compared with 30 of 41 (73%) for the implementation group over the 9-month period following implementation. Following algorithm implementation, opioid infusion rates were decreased and benzodiazepine infusions were nearly eliminated. Dexmedetomidine use and infusion rates did not change. Although mean duration of sedative drug infusions did not change with implementation, the frequency of high outliers was diminished. Duration of mechanical ventilation, length of ICU stay (outcome measures), and the frequency of unplanned extubation (balancing measure) were not affected by implementation.ConclusionsImplementation of a pediatric comfort algorithm reduced opioid and benzodiazepine dosing, without compromising safety for postoperative pediatric cardiac surgical patients.

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