To the Editor In the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial, Dr Curley and colleagues1 found that a nurse-implemented, goal-directed sedation protocol for children undergoing mechanical ventilation for acute respiratory failure did not reduce the duration of mechanical ventilation compared with standard of care. In an accompanying Editorial, Dr Mehta2 raised the question of whether a low adherence rate to a complex protocol (71%-100%) or a difference in administered drugs with bioaccumulation between the groups contributed to the null findings. This large randomized clinical trial of sedation using a bedside protocol in critically ill children may have been confounded by an intervention group who were younger and less sick and who received more frequent assessments.
Remy KE. Sedation Protocol for Critically Ill Pediatric Patients. JAMA. 2015;313(17):1754. doi:10.1001/jama.2015.3459