Effect of a goal-directed sedation nursing intervention bundle on comfort and compliance in children undergoing bronchoalveolar lavage under topical anesthesia with procedural sedation: a randomized controlled trial.

OBJECTIVE

To assess the impacts of goal-directed sedation nursing intervention on comfort and compliance in children undergoing bronchoalveolar lavage (BAL) under topical anesthesia with procedural sedation.

METHODS

A total of 168 children undergoing BAL under topical anesthesia with procedural sedation were randomly assigned to a study group and a control group. After post-randomization exclusions, the final analyzed sample comprised 82 and 81 participants, respectively. The intervention period was from November 2024 to October 2025. Seven outcome measures were assessed: (1) comfort level (primary outcome); (2) procedure compliance; (3) sedation adequacy; (4) procedure duration; (5) vital sign stability; (6) adverse events; and (7) parental satisfaction. Data were collected at baseline and during the procedure.

RESULTS

The mean Comfort-B score was 12.15 ± 2.08 in the study group versus 15.42 ± 2.67 in the control group, with a mean difference of -3.27 points (95% CI -4.02 to -2.52) and a large effect size (Cohen's d = 1.37, 95% CI 1.03-1.71; p < 0.001). The study group also demonstrated significantly better operational compliance (92.68% vs. 79.01%, p = 0.012; OR 3.37, 95% CI 1.26-8.98) and overall compliance (93.90% vs. 80.25%, p = 0.009; OR 3.79, 95% CI 1.32-10.90). Sedation adequacy with a higher proportion achieving optimal sedation (90.24% vs. 70.37%, p = 0.001; OR 3.89, 95% CI 1.63-9.30). Procedure duration was significantly shorter in the study group (12.41 ± 2.26 vs. 15.67 ± 3.12 min, p < 0.001; Cohen's d = 1.20, 95% CI 0.87-1.53). Vital sign stability with significantly smaller fluctuations in heart rate, respiratory rate, and oxygen saturation (all p < 0.001; Cohen's d 1.19-1.87). Parental satisfaction was significantly higher in the study group (93.90% vs. 81.48%, p = 0.008; OR 3.79, 95% CI 1.32-10.90).

CONCLUSION

The multicomponent goal-directed sedation nursing intervention bundle significantly improves comfort, compliance, and sedation adequacy in children undergoing BAL under topical anesthesia with procedural sedation, reduces procedure duration, maintains vital sign stability, and enhances parental satisfaction. Although adverse events were numerically fewer, this difference did not reach statistical significance. This nursing approach provides a safe, effective framework for managing pediatric patients during BAL procedures.