Sevoflurane sedation for weaning from mechanical ventilation in pediatric intensive care unit

Pavčnik, Maja; Grenc, M. Groselj

doi:10.23736/s0375-9393.19.13077-5

Cited by 8 publications

(3 citation statements)

References 28 publications

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“…Sevoflurane has been used in PICU as an adjuvant to morphine infusion, with the AnaConDa system, obtaining weaning from other sedatives in most patients [50]. A recent prospective study confirmed its efficacy in weaning from sedation and ventilation in critically ill children ready to extubation but very agitated and affected by WS [58]. Nowadays, the most effective dose and tolerated duration of treatment are not clear.…”

Section: Strength Of Recommendation: Moderatementioning

confidence: 99%

Recommendations for analgesia and sedation in critically ill children admitted to intensive care unit

Amigoni

Conti

Conio

et al. 2022

J Anesth Analg Crit Care

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We aim to develop evidence-based recommendations for intensivists caring for children admitted to intensive care units and requiring analgesia and sedation. A panel of national paediatric intensivists expert in the field of analgesia and sedation and other specialists (a paediatrician, a neuropsychiatrist, a psychologist, a neurologist, a pharmacologist, an anaesthesiologist, two critical care nurses, a methodologist) started in 2018, a 2-year process. Three meetings and one electronic-based discussion were dedicated to the development of the recommendations (presentation of the project, selection of research questions, overview of text related to the research questions, discussion of recommendations). A telematic anonymous consultation was adopted to reach the final agreement on recommendations. A formal conflict-of-interest declaration was obtained from all the authors. Eight areas of direct interest and one additional topic were considered to identify the best available evidence and to develop the recommendations using the Evidence-to-Decision framework according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. For each recommendation, the level of evidence, the strength of the recommendation, the benefits, the harms and the risks, the benefit/harm balance, the intentional vagueness, the values judgement, the exclusions, the difference of the opinions, the knowledge gaps, and the research opportunities were reported. The panel produced 17 recommendations. Nine were evaluated as strong, 3 as moderate, and 5 as weak. Conclusion: a panel of national experts achieved consensus regarding recommendations for the best care in terms of analgesia and sedation in critically ill children.

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Section: Strength Of Recommendation: Moderatementioning

confidence: 99%

Recommendations for analgesia and sedation in critically ill children admitted to intensive care unit

Amigoni

Conti

Conio

et al. 2022

J Anesth Analg Crit Care

View full text Add to dashboard Cite

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“…29 On the other hand light sedation with dexmedetomidine or inhalational sedation with sevoflurane is promoted nowadays in the ICU in both adults and children. [30][31][32][33] However, a withdrawal syndrome has been associated with prolonged dexmedetomidine infusion in children who were critically ill, as has been found with prolonged opioid or benzodiazepine use, 34 despite the rapid onset and offset of dexmedetomidine action and its short-half life (2 h). Interestingly, Haenecour et al 35 attributed this to a change in the pharmacokinetic profile of dexmedetomidine after a prolonged infusion and to its reduced clearance in infants.…”

Section: Discussionmentioning

confidence: 99%

Short-Acting Sedative-Analgesic Drugs Protect Against Development of Ventilator-Associated Events in Children: Secondary Analysis of the EUVAE Study

et al. 2021

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BACKGROUND: The U.S. Centers for Disease Control and Prevention proposed a shift in its surveillance paradigm from ventilator-associated pneumonia to ventilator-associated events (VAE) to broaden the focus of prevention and achieve a greater impact on outcomes. The main objective of the present study was to identify factors associated with pediatric VAEs in children undergoing mechanical ventilation 6 48 h. METHODS: This was a secondary analysis of a pediatric cohort of a multicenter prospective study. Children who underwent mechanical ventilation 6 48 h were included. Exclusion criteria were previous ventilation, extracorporeal life support, and right-to-left shunt or pulmonary hypertension. In the subjects with multiple episodes of mechanical ventilation, only the first episode was considered. Remifentanil and propofol are classified as shortacting sedative and analgesic agents. Pediatric VAE is defined as an "increase in PEEP 6 2 cm of H 2 O, an increase in F IO 2 of 0.20, or an increase in F IO 2 of 0.15 plus an increase in PEEP 6 1 cm of H 2 O sustained for 61 d. Associations with pediatric VAE were estimated through multivariate Cox proportional hazards analysis. Hazard ratios and 95% CI were computed. RESULTS: In a cohort of 90 children, 24 pediatric VAEs were documented in 906 ventilator-days. Pediatric VAEs developed after a median of 4.5 (interquartile range, 4-7.25) d. Surgical admissions, spontaneous breathing trials, early mobility, vasopressors, red blood cell units transfusion, type of sedation (continuous vs intermittent), benzodiazepine use for >3 d, and pharmacologic paralysis were not associated with pediatric VAE, whereas the use of continuous short-acting sedative-analgesic agents was identified as a strong protective factor against pediatric VAE (hazard ratio 0.06 [95% CI 0.007-0.5]). CONCLUSIONS: Treatment with short-acting sedative-analgesic agents should be preferred for sedation of mechanically ventilated children in intensive care.

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“…Furthermore, anxiety and pain are strongly correlated, and may reinforce each other leading to higher sedatives and analgesics requirements [2,7]. These medications are known to have negative side effects, such as prolonged mechanical ventilation [8][9][10][11][12][13]. Currently, there are limited therapeutic options for anxiety other than analgo-sedation and there are no clear guideline recommendations for non-pharmacologic treatment of anxiety in the ICU [4].…”

Section: Introductionmentioning

confidence: 99%

Effect of a music intervention on anxiety in adult critically ill patients: a multicenter randomized clinical trial

Kakar

Ottens

Stads³

et al. 2022

Preprint

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Background: Previous studies show positive effect of music on reducing anxiety, pain, and medication requirement. Anxiety has become a more pertinent issue in the intensive care unit (ICU) since wakefulness is preferred according to recent guidelines. Nevertheless, evidence on the effect of music in ICU patients is scarce. Therefore, we studied the effect of music intervention on anxiety in ICU patients.Methods: A multicentre randomized clinical trial was conducted between August 2020 and December 2021 in ICU’s at an academic medical center and two regional hospitals. Adult critically ill patients were eligible when hemodynamically stable and communicable (Richmond agitation-sedation scale (RASS) of at least -2). Patients in the intervention arm were offered music twice daily during three days for at least 30 minutes per session. Patients in the control group received standard care. The primary outcome was anxiety level assessed with the visual analogue scale for anxiety [VAS-A; range 0-10] twice daily (morning and evening). Secondary outcomes included; 6-item state-trait anxiety inventory (STAI-6), sleep quality, delirium, heart rate, mean arterial pressure pain, RASS, medication, ICU length of stay, patients’ memory and experience of ICU stay. Results: 94 patients were included in the primary analysis. Music did not significantly reduce anxiety (VAS-A in the intervention group; 2.5(IQR 1.0-4.5), 1.8(0.0-3.6), and 2.5(0.0-3.6) on day 1,2, and 3 versus 3.0(0.6-4.0), 1.5(0.0-4.0), and 2.0(0.0-4.0) in the control group; p>0.92). Overall median daily VAS-A scores ranged from 1.5 to 3.0. Fewer patients required opioids (21 vs. 29, p=0.03) and sleep quality was lower in the music group on study day one (5.0(4.0-6.0) vs. 4.5(3.0-5.0), p=0.03). Other outcomes were similar between groups. Conclusions: Anxiety levels in this ICU population were low, and music did not decrease anxiety. This study indicates that efficacy of music is context and intervention-dependent, given previous evidence showing decreased anxiety. Trial Registration number: Netherlands Trial Register: NL8595, Registered, 1 April 2020ClinicalTrials.gov ID: NCT04796389, Registered retrospectively, 3 April 2021

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Sevoflurane sedation for weaning from mechanical ventilation in pediatric intensive care unit

Cited by 8 publications

References 28 publications

Recommendations for analgesia and sedation in critically ill children admitted to intensive care unit

Recommendations for analgesia and sedation in critically ill children admitted to intensive care unit

Short-Acting Sedative-Analgesic Drugs Protect Against Development of Ventilator-Associated Events in Children: Secondary Analysis of the EUVAE Study

Effect of a music intervention on anxiety in adult critically ill patients: a multicenter randomized clinical trial

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