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sedation withdrawal pediatric critically ill

Cinara Andreolio, Jefferson Pedro Piva, Elisa Baldasso, Roberta Ferlini, Rafaela Piccoli
OBJECTIVE: To describe main indications, doses, length of infusion and side effects related to dexmedetomidine infusion. METHODS: Observational and retrospective study evaluating dexmedetomidine use in pediatric intensive care unit. RESULTS: 77 children received dexmedetomidine infusion longer than 6 hours for mechanical ventilation weaning (32.5%), post- neurosurgery and post-upper airway surgery (24.7%), non-invasive ventilation (13%), refractory tachycardia (6...
November 15, 2016: Indian Pediatrics
Nienke J Vet, Niina Kleiber, Erwin Ista, Matthijs de Hoog, Saskia N de Wildt
This article discusses the rationale of sedation in respiratory failure, sedation goals, how to assess the need for sedation as well as effectiveness of interventions in critically ill children, with validated observational sedation scales. The drugs and non-pharmacological approaches used for optimal sedation in ventilated children are reviewed, and specifically the rationale for drug selection, including short- and long-term efficacy and safety aspects of the selected drugs. The specific pharmacokinetic and pharmacodynamic aspects of sedative drugs in the critically ill child and consequences for dosing are presented...
2016: Frontiers in Pediatrics
Gonzalo Garcia Guerra, Ari R Joffe, Dominic Cave, Jonathan Duff, Shannon Duncan, Cathy Sheppard, Gerda Tawfik, Lisa Hartling, Hsing Jou, Sunita Vohra
BACKGROUND: Despite the fact that almost all critically ill children experience some degree of pain or anxiety, there is a lack of high-quality evidence to inform preferred approaches to sedation, analgesia, and comfort measures in this environment. We conducted this survey to better understand current comfort and sedation practices among Canadian pediatric intensivists. METHODS: The survey was conducted after a literature review and initial focus groups. The survey was then pretested and validated...
September 2016: Pediatric Critical Care Medicine
Paulo Sérgio Lucas da Silva, Maria Eunice Reis, Thais Suelotto Machado Fonseca, Marcelo Cunio Machado Fonseca
BACKGROUND AND AIMS: Although iatrogenic withdrawal syndrome (IWS) has been recognized in patients exposed to opioids and benzodiazepines, very few studies have used a validated tool for diagnosis and assessment of IWS in critically ill children. We sought to determine IWS rate, risk factors, and outcomes of IWS patients. METHODS: Prospective observational study conducted in a pediatric intensive care unit. A total of 137 patients (31 with IWS and 106 with no IWS) received a continuous infusion of fentanyl and midazolam for 3 or more days...
March 2016: Journal of Addiction Medicine
Gennie Jing Wang, Emilie Belley-Coté, Lisa Burry, Mark Duffett, Timothy Karachi, Dan Perri, Waleed Alhazzani, Frederick D'Aragon, Hannah Wunsch, Bram Rochwerg
BACKGROUND: Management and choice of sedation is important during critical illness in order to reduce patient suffering and to facilitate the delivery of care. Unfortunately, medications traditionally used for sedation in the intensive care unit (ICU) such as benzodiazepines and propofol are associated with significant unwanted effects. Clonidine is an alpha-2 selective adrenergic agonist that may have a role in optimizing current sedation practices in the pediatric and adult critically ill populations by potentially minimizing exposure to other sedative agents...
November 6, 2015: Systematic Reviews
Kaitlin M Best, Lisa A Asaro, Linda S Franck, David Wypij, Martha A Q Curley
OBJECTIVE: To characterize sedation weaning patterns in typical practice settings among children recovering from critical illness. DESIGN: A descriptive secondary analysis of data that were prospectively collected during the prerandomization phase (January to July 2009) of a clinical trial of sedation management. SETTING: Twenty-two PICUs across the United States. PATIENTS: The sample included 145 patients, aged 2 weeks to 17 years, mechanically ventilated for acute respiratory failure who received at least five consecutive days of opioid exposure...
January 2016: Pediatric Critical Care Medicine
Andrew Singleton, Robert J Preston, Amalia Cochran
The objective of this study was to assess current practice patterns and attitudes toward pediatric sedation and analgesia in United States (US) burn centers for critically ill patients. Survey-based questionnaire was sent to 119 Directors at US burn centers that care for pediatric patients. Forty-one surveys (34%) were analyzed. 48.8% of responding centers mandate pediatric consultation for pediatric burn patients based on factors such as age and burn size. The most common sedation and analgesic agents used were midazolam, fentanyl, morphine, ketamine, and diphenhydramine...
May 2015: Journal of Burn Care & Research: Official Publication of the American Burn Association
Samantha J Keogh, Debbie A Long, Desley V Horn
AIMS: The aim of this study was to develop and implement guidelines for sedation and analgesia management in the paediatric intensive care unit (PICU) and evaluate the impact, feasibility and acceptability of these as part of a programme of research in this area and as a prelude to future trial work. METHOD: This pilot study used a pre-post design using a historical control. SETTING: Two PICUs at different hospitals in an Australian metropolitan city...
2015: BMJ Open
Felix Neunhoeffer, Matthias Kumpf, Hanna Renk, Malte Hanelt, Nicole Berneck, Axel Bosk, Ines Gerbig, Ellen Heimberg, Michael Hofbeck
BACKGROUND: While several analgesia and sedation guidelines and protocols have been developed and implemented for adults, there is still little evidence of clinical use of analgesia and sedation protocols and the impact on withdrawal symptoms in critically ill children. OBJECTIVE: The aim of this study was to evaluate the effects of a nurse-driven goal-directed analgesia and sedation protocol for mechanically ventilated pediatric patients (pASP) on duration of mechanical ventilation, pediatric intensive care unit (PICU) length of stay, total doses of opioids and benzodiazepines, and occurrence of withdrawal symptoms...
August 2015: Paediatric Anaesthesia
Martha A Q Curley, David Wypij, R Scott Watson, Mary Jo C Grant, Lisa A Asaro, Ira M Cheifetz, Brenda L Dodson, Linda S Franck, Rainer G Gedeit, Derek C Angus, Michael A Matthay
IMPORTANCE: Protocolized sedation improves clinical outcomes in critically ill adults, but its effect in children is unknown. OBJECTIVE: To determine whether critically ill children managed with a nurse-implemented, goal-directed sedation protocol experience fewer days of mechanical ventilation than patients receiving usual care. DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized trial conducted in 31 US pediatric intensive care units (PICUs)...
January 27, 2015: JAMA: the Journal of the American Medical Association
Kaitlin M Best, Joseph I Boullata, Martha A Q Curley
OBJECTIVES: Analgesia and sedation are common therapies in pediatric critical care, and rapid titration of these medications is associated with iatrogenic withdrawal syndrome. We performed a systematic review of the literature to identify all common and salient risk factors associated with iatrogenic withdrawal syndrome and build a conceptual model of iatrogenic withdrawal syndrome risk in critically ill pediatric patients. DATA SOURCES: Multiple databases, including PubMed/Medline, EMBASE, CINAHL, and the Cochrane Central Registry of Clinical Trials, were searched using relevant terms from January 1, 1980, to August 1, 2014...
February 2015: Pediatric Critical Care Medicine
Ya Nee Poh, Pei Fen Poh, Siti Nur Hanim Buang, Jan Hau Lee
OBJECTIVE: To evaluate the impact of sedation guidelines, protocols, and algorithms on clinical outcomes in PICUs. DATA SOURCES: CINAHL, Medline, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews, STUDY SELECTION: : English-only publications from 1966 to December 2013, which included keywords "sedation," "guideline," "algorithm," "protocol," and "pediatric intensive care." We included all primary studies involving critically ill children on sedation guidelines, protocols, and algorithms and excluded those which focused mainly on diagnostic or procedural purposes...
November 2014: Pediatric Critical Care Medicine
Erwin Ista, Matthijs de Hoog, Dick Tibboel, Hugo J Duivenvoorden, Monique van Dijk
OBJECTIVE: The Sophia Observation withdrawal Symptoms scale is an instrument for screening benzodiazepine and opioid withdrawal syndrome in pediatric critical care patients. The objectives of this study were to establish cutoff scores and to test sensitivity to change. Second, risk factors for withdrawal syndrome were explored. DESIGN: Prospective observational study with repeated measures. SETTING: Level IV ICU at a university children's hospital...
October 2013: Pediatric Critical Care Medicine
Nienke J Vet, Erwin Ista, Saskia N de Wildt, Monique van Dijk, Dick Tibboel, Matthijs de Hoog
PURPOSE: Sedatives administered to critically ill children should be titrated to effect, because both under- and oversedation may have negative effects. We conducted a systematic review to examine reported incidences of under-, optimal, and oversedation in critically ill children receiving intensive care. METHODS: A systematic literature search using predefined criteria was performed in PubMed and Embase to identify all articles evaluating level of sedation in PICU patients receiving continuous sedation...
September 2013: Intensive Care Medicine
Mary Jo C Grant, Michele C Balas, Martha A Q Curley
BACKGROUND: Clinical trials exploring optimal sedation management in critically ill pediatric patients are urgently needed to improve both short- and long-term outcomes. Concise operational definitions that define and provide best-available estimates of sedation-related adverse events (AE) in the pediatric population are fundamental to this line of inquiry. OBJECTIVES: To perform a multiphase systematic review of the literature to identify, define, and provide estimates of sedation-related AEs in the pediatric ICU setting for use in a multicenter clinical trial...
May 2013: Heart & Lung: the Journal of Critical Care
Laura Carney, Jennifer Kendrick, Roxane Carr
BACKGROUND: Critically ill children require sedation for comfort and to facilitate mechanical ventilation and interventions. Dexmedetomidine is a newer sedative with little safety data in pediatrics, particularly for therapy lasting longer than 48 h. OBJECTIVE: To quantify the frequency of adverse events and withdrawal syndromes associated with dexmedetomidine and to describe the use of this drug for continuous sedation in critically ill children. METHODS: In this retrospective study of patients who received dexmedetomidine for sedation in the pediatric intensive care unit, adverse events were assessed with the Naranjo scale to determine the likelihood of association with dexmedetomidine...
January 2013: Canadian Journal of Hospital Pharmacy
A Amigoni, I Catalano, E Vettore, L Brugnaro, A Pettenazzo
BACKGROUND: No strong recommendation was reported in management analgesia and sedation of critically ill children. The present study was performed to describe the current practice of analgesia and sedation in Pediatric Italian Intensive Care Units, in order to evaluate the adherence to last published pediatric guidelines. METHODS: A questionnaire was sent to 24 Italian Paediatric Intensive Care Units during 2010. RESULTS: One Hundred percent of contacted centers returned the filled form...
December 2012: Minerva Anestesiologica
Punkaj Gupta, Wendy Whiteside, Arash Sabati, Tiffany M Tesoro, Jeffrey M Gossett, Joseph D Tobias, Stephen J Roth
OBJECTIVES: To evaluate the safety and efficacy of prolonged dexmedetomidine administration (≥ 96 hrs) in critically ill children with heart disease. DESIGN: Retrospective observational study. SETTING: Cardiovascular intensive care unit in a single, tertiary care, academic children's hospital. INTERVENTIONS: None. SUBJECTS: We conducted a retrospective review of the charts of all critically ill infants and children (up to 18 yrs of age) with congenital or acquired heart disease who received dexmedetomidine for ≥ 96 hrs in our pediatric cardiovascular intensive care unit between January 2009 and March 2010...
November 2012: Pediatric Critical Care Medicine
Sonia A Jeffries, Rumi McGloin, Alexander F Pitfield, Roxane R Carr
BACKGROUND: Opioids are commonly administered to critically ill children for analgesia and sedation, but many patients experience opioid withdrawal upon discontinuation. The authors' institution developed a protocol for using methadone to prevent opioid withdrawal in children who have received morphine by continuous IV infusion for 5 days or longer in the pediatric intensive care unit (PICU). OBJECTIVES: The primary objectives were to determine if opioids were tapered according to the protocol and to determine the conversion ratio for IV morphine to oral methadone that was used...
January 2012: Canadian Journal of Hospital Pharmacy
Mary Jo C Grant, Lisa A Scoppettuolo, David Wypij, Martha A Q Curley
OBJECTIVES: Sedation-related adverse events in critically ill pediatric patients lack reproducible operational definitions and reference standards. Understanding these adverse events is essential to improving the quality of patient care and for developing prevention strategies in critically ill children. The purpose of this study was to test operational definitions and estimate the rate and site-to-site heterogeneity of sedation-related adverse events. DESIGN: Prospective cohort study...
April 2012: Critical Care Medicine
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