New Study from UPMC Children's Finds Alternative Sedation Strategies Safe and Effective for Infant Pulmonary Function Testing
March 2, 2026
Chloral hydrate has been the standard for sedation for infant pulmonary function testing (iPFT) since the technique was developed. Commercial production of chloral hydrate syrup products stopped in 2012. That, coupled with limitations and issues related to compounding the agents as needed have forced many pediatric pulmonary medicine programs to adapt and find alternative sedatives with the required properties compatible with iPFT.
A new study from the Division of Pediatric Pulmonary Medicine at UPMC Children's Hospital of Pittsburgh provides clinicians with some of the first evidence to guide clinical decision making.
The study was published in Jan. 2026 in Pediatric Pulmonology. Aditi K. Zaveri, MD, former Division fellow, was the study's lead author. Daniel J. Weiner, MD, medical director of the Pulmonary Function Testing Laboratory, and Kristina Gaietto, MD, MPH, were the study’s co-senior authors.
“This is the first published study to directly compare alternative iPFT sedation strategies to chloral hydrate, making it a potentially useful reference for pediatric pulmonary medicine programs working in a setting where chloral hydrate is becoming increasingly difficult to obtain for clinical use,” Dr. Gaietto says.
About the Study and its Clinical Implications on Patient Care
Dr. Zaveri and colleagues retrospectively reviewed iPFTs performed at UPMC Children's over a three-year period, comparing testing outcomes using four different approaches to sedation. These included CH, ketamine combined with midazolam, dexmedetomidine, and a combination approach using two or more sedatives. Most of the patients in the study had cystic fibrosis, which is one of the more common conditions for which iPFT is used.
The study found that test quality was comparable with all four sedation strategies that were used and analyzed by the team.
“Our findings suggest that pediatric pulmonologists and anesthesiologists can reasonably expect that iPFTs conducted under ketamine and midazolam or dexmedetomidine sedation will give test results of similar quality to what would be expected with chloral hydrate, without meaningfully increasing the total time required to complete testing,” Dr. Gaietto says.
The polypharmacy approach, which typically involved the addition of propofol when initial sedation was failing, was associated with longer recovery and total testing times and was the reason for the majority of adverse events the team observed in the study, all of which were mild and resolved without further complication.
"Our findings provide preliminary evidence that Ketamine, dexmedetomidine, and combination approaches may be safe and effective alternatives to chloral hydrate for iPFT sedation," Dr. Wiener says. "This is important because in order to get useable data from the test in very young patients, we have to use sedation but need options that are compatible with the diagnostic testing needs. It’s probably unlikely that CH production will ever return to the way it used to be, so pediatric pulmonary medicine teams have to adapt. Our study gives the field preliminary findings to further expand on in larger, multicenter studies ."
Study Reference
Read the entire study using the link below. The paper is open access.
Learn more about the Division of Pediatric Pulmonary Medicine at UPMC Children's Hospital of Pittsburgh.
