Randomized controlled trial of interrupted versus continuous sedative infusions in ventilated children

Gupta, Kunal; Gupta, Vipul K; Jayashree, Muralidharan; Singhi, Sunit

doi:10.1097/pcc.0b013e31820aba48

Cited by 97 publications

(83 citation statements)

References 15 publications

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“…Gupta et al demonstrated a decrease in duration of ventilatory support, leading to a reduction from 13.01 days in the control group to 8.4 days in the daily interruption group (p=0.028); shorter length of ICU stay, from 14 days in the control group to 11 days in the intervention group (p=0.023); lower doses of midazolam used in the daily interruption group (p=0.002), implicating lower hospitalization costs without an increase in the number of adverse events. 35 Another study, by Verlaat et al, showed similar results, with a significant decrease in sedative and analgesic agents used; less time of mechanical ventilation and decreased length of ICU stay with no increase in the numbers of adverse events. 36 A recent study by Vet NJ et al, however, did not show much benefit in the use of daily interruption strategies to shorten the duration of mechanical ventilation or hospitalization, or the quantities of sedatives used, with the use of these strategies potentially associated with a higher 30-day mortality rate, without explaining the reasons behind this fact.…”

Section: Resultssupporting

confidence: 54%

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Motta

Luglio²,

Delgado

et al. 2016

Rev. Assoc. Med. Bras.

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Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

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Section: Resultssupporting

confidence: 54%

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Motta

Luglio²,

Delgado

et al. 2016

Rev. Assoc. Med. Bras.

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“…In children, continuous sedation is associated with longer mechanical ventilation, 31 whereas daily interruption of sedation is associated with shorter mechanical ventilation. 32 Altered mental status and absence of airway reflexes at the time of extubation are associated with extubation failure in children, 33 but inadequate sedation is also associated with unplanned extubation and post-extubation stridor. 34 The majority of our respondents consider sedation an important element in extubation readiness but do not use a formal standardized sedation score; instead they use their own clinical judgment.…”

Section: Discussionmentioning

confidence: 99%

The Use of Extubation Readiness Parameters: A Survey of Pediatric Critical Care Physicians

et al. 2013

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BACKGROUND:The pediatric literature addressing extubation readiness parameters and strategies to wean from mechanical ventilation is limited. METHODS: We designed a survey to assess the use of extubation readiness parameters among pediatric critical care physicians at academic centers in the United States. RESULTS: The overall response rate was 44.1% (417/945). The majority of respondents check for air leak and the amount of tracheal secretions. Fewer respondents use sedation score, the rapid shallow breathing index, or the airway-occlusion pressure 0.1 s after the start of inspiratory flow prior to extubation. The majority perform a spontaneous breathing trial with pressure support. The majority consider 30 cm H 2 O as the upper limit of an air leak test, and the need for endotracheal suctioning once every 2-4 hours as acceptable for extubation. In preparation for termination of mechanical ventilation the majority daily wean the ventilator rate and/or the pressure support instead of conducting a spontaneous breathing trial. CONCLUSIONS: Most pediatric critical care physicians reported assessing extubation readiness by checking air leak and suctioning need, and less often consider or perform sedation score or the rapid shallow breathing index.

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“…The results of this current study could simply reflect the strong history in the Netherlands of good sedation practice including a relative sparing use of sedatives. This is supported by the relatively low dose of midazolam used compared to a previous paediatric study [7]. One conclusion is that recovery from sedation relates to the overall cumulative ''sedation burden'' and that minimizing the exposure, with effective behavioural scoring linked to delivery, optimizes recovery irrespective of DSI and other factors.…”

mentioning

confidence: 88%

“…The value of DSI [5][6][7] remains unclear. The results of this current study could simply reflect the strong history in the Netherlands of good sedation practice including a relative sparing use of sedatives.…”

mentioning

confidence: 99%

Tolerance to sedative drugs in PICU: can it be moderated or is it immutable?

2015

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Dear Editor, Nienke Vet and colleagues have evaluated the influence of daily sedation interruptions (DSI) in PICU [1]. This was ambitious: bias is hard to avoid and recruitment rates in such studies are poor, which ultimately restrict the strength of conclusions. Nevertheless, their results suggest that, if behavioural tools already drive sedation delivery, then DSI will not substantially influence the duration of ventilation. These findings are consistent with recent reports from adult intensive care [2].A pause in drug delivery allows plasma concentration to fall followed by reduction in effect site concentration and subsequent arousal. However, the lag time can be significant (Fig. 1a). Recovery may be further delayed by the presence and influence of midazolam's alpha-hydroxy metabolite that has half the activity of the parent drug [3]. Other drugs used for sedation also have influence: a three-

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Randomized controlled trial of interrupted versus continuous sedative infusions in ventilated children

Abstract: The length of mechanical ventilation, duration of intensive care unit stay, total dose of midazolam, and average calculated cost of the therapy were significantly reduced in the interrupted as compared to the continuous group of sedation.

Cited by 97 publications

References 15 publications

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

The Use of Extubation Readiness Parameters: A Survey of Pediatric Critical Care Physicians

Tolerance to sedative drugs in PICU: can it be moderated or is it immutable?

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