33 / 280
Conclusions
We identified variability in sedation wean practices and op-
portunities for communication improvement. We imple-
mented systemwide process change using IHI methodology
with the goal of improving care based on best practice guide-
lines, which significantly decreased the time required for se-
dation wean. Our approach to a sedation wean communica-
tion in the LTR patient populationmay be potentially studied
in other more heterogeneous patient populations requiring
standardized sedation wean protocols.
ARTICLE INFORMATION
Submitted for Publication:
May 21, 2014; final
revision received August 12, 2014; accepted
September 15, 2014.
Published Online:
October 30, 2014.
doi:10.1001/jamaoto.2014.2694.
Author Contributions:
Drs Kozin and Cummings
had full access to all of the data in the study and
take responsibility for the integrity of the data and
the accuracy of the data analysis.
Study concept and design:
Kozin, Cummings,
Rogers, Noviski.
Acquisition, analysis, or interpretation of data:
Kozin, Cummings, Lin, Sethi, Noviski, Hartnick.
Drafting of the manuscript:
Kozin, Cummings,
Noviski.
Critical revision of the manuscript for important
intellectual content:
All authors.
Statistical analysis:
Kozin, Cummings, Sethi,
Noviski.
Administrative, technical, or material support:
Kozin, Cummings, Lin.
Study supervision:
Kozin, Rogers, Noviski, Hartnick.
Conflict of Interest Disclosures:
None reported.
Previous Presentation:
This study was presented
as an oral presentation at American Society for
Pediatric Otolaryngology, Combined
Otolaryngological Spring Meeting; May 17, 2014;
Las Vegas, Nevada.
REFERENCES
1
. Herrington HC, Weber SM, Andersen PE. Modern
management of laryngotracheal stenosis.
Laryngoscope
. 2006;116(9):1553-1557.
2
. Santos D, Mitchell R. The history of pediatric
airway reconstruction.
Laryngoscope
. 2010;120(4):
815-820.
3
. Stauffer JL, Olson DE, Petty TL. Complications
and consequences of endotracheal intubation and
tracheotomy.
Am J Med
. 1981;70(1):65-76.
4
. Fearon B, Cotton R. Surgical correction of
subglottic stenosis of the larynx.
Ann Otol Rhinol
Laryngol
. 1972;81(4):508-513.
5
. Gallagher TQ, Hartnick CJ. Laryngotracheal
reconstruction.
Adv Otorhinolaryngol
. 2012;73:
31-38.
6
. Cotton RT, Gray SD, Miller RP. Update of the
Cincinnati experience in pediatric laryngotracheal
reconstruction.
Laryngoscope
. 1989;99(11):1111-1116.
7
. Hammer GB. Sedation and analgesia in the
pediatric intensive care unit following
laryngotracheal reconstruction.
Otolaryngol Clin
North Am
. 2008;41(5):1023-1044.
8
. Jacobs BR, Salman BA, Cotton RT, Lyons K, Brilli
RJ. Postoperative management of children after
single-stage laryngotracheal reconstruction.
Crit
Care Med
. 2001;29(1):164-168.
9
. Roeleveld PP, Hoeve LJ, Joosten KF, de Hoog M.
Short use of muscle relaxants following single stage
laryngotracheoplasty in children.
Int J Pediatr
Otorhinolaryngol
. 2005;69(6):751-755.
10
. Rothschild MA, Cotcamp D, Cotton RT.
Postoperative medical management in single-stage
laryngotracheoplasty.
Arch Otolaryngol Head Neck
Surg
. 1995;121(10):1175-1179.
11
. Rowe RW, Betts J, Free E. Perioperative
management for laryngotracheal reconstruction.
Anesth Analg
. 1991;73(4):483-486.
12
. Yellon RF, Parameswaran M, Brandom BW.
Decreasing morbidity following laryngotracheal
reconstruction in children.
Int J Pediatr
Otorhinolaryngol
. 1997;41(2):145-154.
13
. Tobias JD. Tolerance, withdrawal, and physical
dependency after long-term sedation and analgesia
of children in the pediatric intensive care unit.
Crit
Care Med
. 2000;28(6):2122-2132.
14
. Wolf A, Jenkins I. Sedation of the critically ill
child.
Curr Paediatr
. 2005;15(4):316-323.
15
. Playfor S, Jenkins I, Boyles C, et al; United
Kingdom Paediatric Intensive Care Society
Sedation; Analgesia and Neuromuscular Blockade
Working Group. Consensus guidelines on sedation
and analgesia in critically ill children.
Intensive Care
Med
. 2006;32(8):1125-1136.
16
. Vet NJ, de Wildt SN, Verlaat CW, et al; SKIC
(Dutch Collaborative PICU Research Network).
Daily interruption of sedation in critically ill children.
Trials
. 2014;15:55.
17
. Franck LS, Scoppettuolo LA, Wypij D, Curley
MA. Validity and generalizability of the Withdrawal
Assessment Tool-1 (WAT-1) for monitoring iatrogenic
withdrawal syndrome in pediatric patients.
Pain
.
2012;153(1):142-148.
18
. Schall M, Rutherford P, Taylor J, Federico F.
Guide for Field Testing: Creating an Ideal Transition
to the Clinical Office Practice.
Cambridge, MA:
Institute for Healthcare Improvement; 2009.
19
. Anand K, Willson D, Berger J, et al; Eunice
Kennedy Shriver National Institute of Child Health
and Human Development Collaborative Pediatric
Critical Care Research Network. Tolerance and
withdrawal from prolonged opioid use in critically ill
children.
Pediatrics
. 2010;125:e1208-e1225.
20
. Setlur J, Maturo S, Hartnick CJ. Novel method
for laryngotracheal reconstruction.
Ann Otol Rhinol
Laryngol
. 2013;122(7):445-449.
21
. Tobias JD. Methadone: who tapers, when,
where, and how?
Pediatr Crit Care Med
. 2014;15(3):
268-270.
22
. Steineck KJ, Skoglund AK, Carlson MK, Gupta S.
Evaluation of a pharmacist-managed methadone
taper.
Pediatr Crit Care Med
. 2014;15(3):206-210.
23
. Catchpole KR, de Leval MR, McEwan A, et al.
Patient handover from surgery to intensive care:
using Formula 1 pit-stop and aviation models to
improve safety and quality.
Paediatr Anaesth
. 2007;
17(5):470-478.
24
. Conroy KM, Elliott D, Burrell AR. Developing
content for a process-of-care checklist for use in
intensive care units.
BMC Health Serv Res
. 2013;13:
380.
25
. Gutsche JT, Kornfield ZN, Speck RM, Patel PA,
Atluri P, Augoustides JG. Impact of guideline
implementation on transfusion practices in a
surgical intensive care unit.
J Cardiothorac Vasc
Anesth
. 2013;27(6):1189-1193.
26
. Hannam JA, Glass L, Kwon J, et al.
A prospective, observational study of the effects of
implementation strategy on compliance with a
surgical safety checklist.
BMJ Qual Saf
. 2013;22(11):
940-947.
27
. Nagpal K, Vats A, Ahmed K, Vincent C, Moorthy
K. An evaluation of information transfer through
the continuum of surgical care: a feasibility study.
Ann Surg
. 2010;252(2):402-407.
28
. Kim SW, Maturo S, Dwyer D, et al.
Interdisciplinary development and implementation
of communication checklist for postoperative
management of pediatric airway patients.
Otolaryngol Head Neck Surg
. 2012;146(1):129-134.
29
. Byrnes MC, Schuerer DJ, SchallomME, et al.
Implementation of a mandatory checklist of
protocols and objectives improves compliance with
a wide range of evidence-based intensive care unit
practices.
Crit Care Med
. 2009;37(10):2775-2781.
30
. Abraham J, Kannampallil TG, Almoosa KF, Patel
B, Patel VL. Comparative evaluation of the content
and structure of communication using two handoff
tools.
J Crit Care
. 2014;29(2):e1-e7.
31
. Derienzo C, Lenfestey R, Horvath M, Goldberg
R, Ferranti J. Neonatal intensive care unit handoffs:
a pilot study on core elements and epidemiology of
errors.
J Perinatol
. 2014;34(2):149-152.
32
. Vergales J, Addison N, Vendittelli A, et al.
Face-to-face handoff: improving transfer to the
pediatric intensive care unit after cardiac Surgery
[published online January 17, 2014].
Am J Med Qual
.
2014.
33
. Gravenstein D, Ford S, Enneking FK.
Anesthesiology leadership rounding.
Perm J
. 2012;
16(4):37-40.
34
. Shah RK, Nussenbaum B, Kienstra M, et al.
Wrong-site sinus surgery in otolaryngology.
Otolaryngol Head Neck Surg
. 2010;143(1):37-41.
35
. Shah RK, Kentala E, Healy GB, Roberson DW.
Classification and consequences of errors in
otolaryngology.
Laryngoscope
. 2004;114(8):
1322-1335.
36
. Soler ZM, Smith TL. Endoscopic sinus surgery
checklist.
Laryngoscope
. 2012;122(1):137-139.
Sedation Wean After Laryngotracheal Reconstruction
Original Investigation
Research
jamaotolaryngology.comJAMA Otolaryngology–Head &Neck Surgery
Published online October
30, 2014
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