Midazolam is a benzodiazepine sedative used in NICUs. Because benzodiazepine’s effects include respiratory depression and potential detrimental developmental effects, minimizing exposure could benefit neonates. Dexmedetomidine is routinely used for sedation in older pediatric populations. We implemented a quality improvement initiative with the aim of decreasing midazolam infusions by 20% through use of dexmedetomidine.

A multidisciplinary committee created a sedation guideline that included standardized dexmedetomidine dosing escalation and weaning. Baseline data collection occurred from January 2015 to February 2018, with intervention from March 2018 to December 2019. Percentage of sedation episodes with dexmedetomidine initiated was followed as a process measure. Outcomes measures were percentage of eligible infants receiving midazolam infusions and midazolam-free days per sedation episode. Bradycardia with dexmedetomidine, unplanned extubation rates, and morphine dosage were monitored as balancing measures.

Our study included 434 episodes of sedation in 386 patients. Dexmedetomidine initiation increased from 18% to 49%. The intervention was associated with a significant reduction in midazolam initiation by 30%, from 95% to 65%, with special cause variation on statistical process control chart analysis. Midazolam-free days per sedation episode increased from 0.3 to 2.2 days, and patients receiving dexmedetomidine had lower midazolam doses (1.3 mg/kg per day versus 2.2 mg/kg per day, P = 5.97 x 10^–04). Bradycardia requiring discontinuation of dexmedetomidine, unplanned extubation rates, and morphine doses were unchanged.

Implementation of a quality improvement initiative was successful in reducing the percentage of patients receiving midazolam infusions and increased midazolam-free days per sedation episode, revealing an overall reduction in benzodiazepine exposure while maintaining adequate sedation.

咪达唑仑是一种用于 NICU 的苯二氮卓类镇静剂。由于苯二氮卓类药物的影响包括呼吸抑制和潜在的有害发育影响，因此尽量减少接触苯二氮卓类药物可能对新生儿有益。右美托咪定通常用于老年儿科人群的镇静。我们实施了一项质量改进计划，旨在通过使用右美托咪定将咪达唑仑输注量减少 20%。

多学科委员会制定了镇静指南，其中包括标准化右美托咪定剂量递增和断药。基线数据收集发生于 2015 年 1 月至 2018 年 2 月，干预时间为 2018 年 3 月至 2019 年 12 月。使用右美托咪定启动镇静发作的百分比作为过程测量进行跟踪。结果指标是接受咪达唑仑输注的合格婴儿的百分比以及每次镇静期间不使用咪达唑仑的天数。作为平衡措施，监测右美托咪定心动过缓、计划外拔管率和吗啡剂量。

我们的研究包括 386 名患者的 434 次镇静。右美托咪定起始使用率从 18% 增加至 49%。干预措施使咪达唑仑起始使用量显着减少 30%，从 95% 降至 65%，统计过程控制图分析中存在特殊原因变异。每次镇静发作的无咪达唑仑天数从 0.3 天增加至 2.2 天，接受右美托咪定的患者咪达唑仑剂量较低（每天 1.3 mg/kg 与每天 2.2 mg/kg， P = 5.97 x 10 ^–04 ）。需要停用右美托咪定的心动过缓、计划外拔管率和吗啡剂量没有变化。

质量改进计划的实施成功地降低了接受咪达唑仑输注的患者比例，并增加了每次镇静发作的无咪达唑仑天数，表明苯二氮卓类药物暴露总体减少，同时保持充分镇静。