Table 2. Review of before-and-after sedation protocol implementation studies and reported outcomes.

Author	Sedation assessment	Duration of MV	PICU LOS	Sedation-related adverse events†	IWS	Sedation doses	Sedation assessments
Dreyfus et al. (27)	COMFORT-B	Unchanged	Unchanged	No	Trend towards decrease	No difference	Increase in target sedation scores. Decrease in over-sedated scores
Gaillard-Le Roux et al. (28)	COMFORT-B	Unchanged	Unchanged	No	No difference	Decrease in midazolam and ketamine dose	No difference
Neunhoeffer et al. (29)	COMFORT-B	Unchanged	Unchanged	No	Decreased	Decrease in benzodiazepine dose	Increase in sedation assessments. More episodes of under-sedation reported
Ista et al. (30)	COMFORT-B	N/A	N/A	N/A	N/A	Increase in morphine and midazolam dose	Increase in target sedation scores
Larson and McKeever (31)	COMFORT-B	Increased	N/A	N/A	N/A	Decrease in midazolam dose; decrease in morphine infusions, with increase in bolus doses	Increase in frequency of sedation assessments
Alexander et al. (18)	Behavioral cues	N/A	N/A	N/A	N/A	Increased sedation received on protocol	Decreased under-sedation
Larson et al. (20)	COMFORT-B	N/A	N/A	N/A	N/A	Decrease in ketamine	Increase in sedation assessments and in documentation and communication of sedation goals
Deeter et al. (33)	Seattle PICU Comfort Score	Unchanged	Unchanged	Decrease in accidental extubation	–	Reduced days of sedatives	Not reported
Jin et al. (21)	COMFORT	Decreased	Decreased	N/A	Decreased	Decrease in sedative doses	Not reported

^†, sedation-related adverse events include unplanned extubation, line removal, and ventilator-associated pneumonia. MV, mechanical ventilation; PICU, pediatric intensive care unit; LOS, length of stay; IWS, iatrogenic withdrawal syndrome; N/A, not assessed.