Randomized controlled trial of daily interruption of sedatives in critically ill children.

Abstract

AIM:

To study the feasibility of daily interruption of sedatives in critically ill children.

METHODS:

Prospective randomized controlled open-label trial, performed in a pediatric intensive care unit of a tertiary care teaching and referring hospital. 30 children (0-12 years) receiving mechanically ventilation for >24 h were included. In the intervention group, all sedatives were stopped daily and restarted when COMFORT-behavior score ≥17. The control group received standard care. Primary end points were amounts of sedatives and number of bolus medications in the first 3 days after enrollment and number of (near) incidents. Secondary end points were duration of mechanical ventilation, length of stay in pediatric intensive care, and changes in COMFORT-behavior score.

RESULTS:

Midazolam and morphine use were lower in the intervention group compared with the control group (P = 0.007 and P = 0.02, respectively), whereas the number of bolus medications did not differ between groups. Two complications were recorded: one patient (intervention group) lost his intravenous line, and one patient (control group) had an unplanned extubation. Duration of mechanical ventilation was significantly shorter in the intervention group compared with the control group (median [interquartile range] of 4 [3-8] and 9 [4-10] days, respectively, P = 0.03). Length of stay in the PICU in the intervention group was significantly shorter than in the control group (median [interquartile range] of 6 [4-9] and 10 [7-15] days, respectively, P = 0.01).

CONCLUSIONS:

Daily interruption of sedatives in critically ill children is feasible, results in decreased use of sedation, earlier extubation, and shorter length of stay.

• Authors: Carin W M Verlaat, Ger P Heesen, Nienke J Vet, Matthijs de Hoog, Johannes G van der Hoeven, Matthijs Kox, Peter Pickkers
• Journal: Paediatric anaesthesia (Paediatr Anaesth) Vol. 24 Issue 2 Pg. 151-6 (Feb 2014) ISSN: 1460-9592 [Electronic] France
• PMID: 23980693 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2013 John Wiley & Sons Ltd.

Chemical References

• Analgesics, Opioid
• Hypnotics and Sedatives
• Morphine
• Midazolam

Topics

• Airway Extubation
• Airway Management
• Analgesics, Opioid (administration & dosage, therapeutic use)
• Child
• Child, Preschool
• Critical Illness (therapy)
• Drug Utilization
• Endpoint Determination
• Feasibility Studies
• Female
• Humans
• Hypnotics and Sedatives (administration & dosage, adverse effects, therapeutic use)
• Infant
• Infant, Newborn
• Kaplan-Meier Estimate
• Length of Stay
• Male
• Midazolam (administration & dosage, adverse effects, therapeutic use)
• Morphine (administration & dosage, therapeutic use)
• Prospective Studies
• Respiration, Artificial
• Survival Analysis