PSHP 2026 Residency Conference

Purpose: This study compared the trends of total daily dose (TDD) of sedation and paralytic medications in intubated pediatric patients prior to and after the implementation of the State Behavioral Scale (SBS) and Cornell Assessment of Pediatric Delirium (CAPD). 


Methods: This was an IRB-exempt single center retrospective chart review taking place during three different time periods in the pediatric intensive care unit (PICU) at Penn State Health Golisano Children’s Hospital (PSHGCH). Study periods were defined as follows: Stage 1, (January 1, 2017-December 31, 2018) prior to the implementation of both SBS and CAPD; Stage 2 (March 5, 2024-January 31, 2025), following SBS but prior to CAPD implementation; and Stage 3 (February 1, 2025-August 31, 2025), after implementation of both SBS and CAPD. In each cohort, TDD was calculated for all sedative, paralytic, and delirium agents. Daily sedation burden was calculated using the Pediatric Normalized sedation Index (PNSI), which provides an objective measure of sedation burden for the patient. The primary outcome of this study is to compare sedative and paralytic use before and after the implementation of SBS and CAPD. Data analysis was done using the Kruskal-Wallis test. 


Results: 526 patients were screened with the inclusion of 134 patients in the final analysis. Baseline characteristics were well balanced across groups, with no meaningful differences observed except length of intubation (p = 0.0496).  PNSI differed overall across all time points combined and changed differently overtime with an apparent increase in sedation use during Stage 2 and subsequent decrease in sedation use during Stage 3 (Group p <0.001; Interaction p <0.0010). PNSI on each individual day was not statistically significant except for day 1 (p < 0.001). Vecuronium use differed across all time points combined but did not distinctly change over time (Group p < 0.001; Interaction p = 0.1008). 


Conclusion: Sedation use increased during Stage 2 following implementation of SBS scoring and subsequently decreased during Stage 3 with the implementation of CAPD scoring. Trends in paralytic use remained inconclusive and limited clinical interpretation. Larger future studies are needed to better evaluate these patterns and determine the clinically meaningful impact of SBS and CAPD on both sedation and paralytic use.