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.
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.
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.
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.
