Long-Term Inhalative Sedation in Children With Pulmonary Diseases

Abstract

Objectives: To describe safety and feasibility of long-term inhalative sedation (LTIS) in children with severe respiratory diseases compared to patients with normal lung function with respect to recent studies that showed beneficial effects in adult patients with acute respiratory distress syndrome (ARDS). Design: Single-center retrospective study. Setting: 12-bed pediatric intensive care unit (PICU) in a tertiary-care academic medical center in Germany. Patients: All patients treated in our PICU with LTIS using the AnaConDa® device between July 2011 and July 2019. Measurements and Main Results: Thirty-seven courses of LTIS in 29 patients were analyzed. LTIS was feasible in both groups, but concomitant intravenous sedatives could be reduced more rapidly in children with lung diseases. Cardiocirculatory depression requiring vasopressors was observed in all patients. However, severe side effects only rarely occured. Conclusions: In this largest cohort of children treated with LTIS reported so far, LTIS was feasible even in children with severely impaired lung function. From our data, a prospective trial on the use of LTIS in children with ARDS seems justified. However, a thorough monitoring of cardiocirculatory side effects is mandatory.

Volatile gas scavenging in the paediatric intensive care unit: Occupational health and safety assessment

“…The use of these devices remains limited in paediatrics, with limited practice guidance on scavenging safety, given the specific needs of placing the device on the the ventilator inspiratory limb with need for higher infusion rate of volatile agents and active humidification. Our study adds to the growing body of literature 5,6 on the safety of using miniature vapourizing devices and inhalational volatile based sedation in critically ill paediatric patients. An ongoing paediatric pilot, clinical trial (NCT04684238 and NCT05867472), will further increase our understanding of the feasibility and safety of using inhalational volatile gases for sedation in critically ill paediatric patients.…”

“…21,22 Historically, the most common indication for the use of volatile gases in paediatric critical care has been to treat bronchospasm in children with severe status asthmaticus that is refractory to conventional therapies. [22][23][24] It has also been utilized in children who are challenging to sedate 5,6 and as a treatment for refractory status epilepticus. 25 While the use of volatile agents in paediatrics has existed for many years, the widespread adoption or availability of this therapy in the critical care environment has been limited by equipment and trained operators.…”

“…An alternative position that places the ACD®-S on the inspiratory outlet of the ventilator has permitted the use of volatile gases for sedation in infants and children with tidal volumes between 30-200mL. 5,6 This position eliminates any additional dead space to the ventilator circuit, but the ACD no longer recycles volatile agent exhaled by the patient and does not provide effective humidification. In this context, it is anticipated that higher infusion rates of the anesthetic may be required in addition to the use of active humidification.…”