Sedation Liberation in the PICU: A Retrospective Observational Study
CCCF ePoster library. Caldwell D. Nov 7, 2018; 233379; 44 Disclosure(s): Nothing to disclose
Deanna Caldwell
Deanna Caldwell
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Abstract
Rate & Comment (0)

Introduction: Discontinuing sedatives in children after critical illness is challenging and multifactorial. Clinicians must consider many different aspects including the weaning of sedative medications and the assessment, prevention and treatment of iatrogenic withdrawal, when liberating children from sedatives.

Objective: Our objective was to describe the current sedation liberation practices at McMaster Children’s Hospital.

Methods: This retrospective observational study included children admitted to the pediatric intensive care unit (PICU) who received sedation and at least 48 hours of invasive ventilation during a 12-month period. We collected data from PICU admission to 3 days after sedative discontinuation.  

Results: We included 67 children. The median (interquartile range [IQR]) age was 1.6 (0.2, 6.2) years, and respiratory illnesses were the most common reason for admission (41 [61%]). Children received invasive ventilation for a median (IQR) of 7 (4, 11) days and received sedation for a median (IQR) of 12 (6, 12) days, with sedation after extubation continuing for a median of 4 (4, 14) days. Sixty-six (99%) children received an opioid and all received a benzodiazepine, with a median (IQR) cumulative dose of 14.1 (4.7, 27) mg/kg and 15.1 (5.9, 31.5) mg/kg, respectively. Dexmedetomidine was used for 31 (46%) children for a median (IQR) of 8 (4, 12) days. Forty-two (63%) children had at least one Withdrawal Assessment Tool-1 (WAT-1) score indicative of iatrogenic withdrawal. Withdrawal occurred for a median (IQR) of 4 (2, 8) days total. Children who experienced withdrawal were exposed to more opioids (1.6 vs 0.7 mg/kg/day; p <0.001) and more benzodiazepines (2.2 vs 1.3 mg/kg/day; p <0.001) for longer periods of time (15 vs 5 days; p <0.0001 and 13.5 vs 3 days; p <0.001).

Conclusions: This observational study highlights there are important variabilities in practice, children receive sedation for a substantial period, and withdrawal is common. These represent future opportunities to improve children’s comfort and outcomes.

 


    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.


Save Settings