Author Of 2 Presentations
THE USE OF NEUROMUSCULAR BLOCKING AGENTS IS ASSOCIATED WITH A HIGHER MORTALITY RATE IN PATIENTS ADMITTED TO PEDIATRIC INTENSIVE CARE: A MULTICENTER REPORT
Abstract
Background
Few data are available about patients receiving neuromuscular blocking agents (NMBAs) in pediatric intensive care units (PICU). Their use is often reported without clear and definite indications with conflicting data about the outcome of these patients.
Objectives
To describe the characteristics and outcome of children receiving prolonged NMBAs treatment in PICU.
Methods
Retrospective, multicenter study using a prospective electronic web-based-national-registry (Pediatric Intensive Care Unit Study Group Network-TIPNET) of patients admitted to 18 Italians’ PICUs (January 2010-October 2017). We included children (<18 years-of-age) receiving mechanical ventilation (MV) and compared patients who received NMBAs (Cur+) with children who did not receive them (Cur-).
Results
A total of 3848 patients were included, 504 (13%) Cur+. There were no significant differences about gender, comorbidities and PIM3 score between the two populations. Cur+ had a significantly lower age (20months [interquartile range (IQR) 5-65] vs 30months [IQR 8-83],p<0.001) and weight (10kg [IQR 5-18] vs 12kg [IQR 7-21]),p<0.001). They received MV more for respiratory (50%vs29%,p<0.001) and less for cardiac diseases (10%vs31%,p<0.001). Cur+ showed longer ventilation duration (6days [IQR 2-12] vs 3days [IQR 1-6],p<0.001) and a higher rate of use of high frequency oscillatory ventilation (18%vs3%,p<0.001). A logistic regression adjusted for age, gender and ventilation modality demonstrated a correlation between NMBAs use and mortality (p<0.001).
Conclusion
A non-negligible proportion of children in PICUs received NMBAs. Their use was more frequent in younger age, it is associated with prolonged use of MV and a higher mortality. Further studies are needed to clarify the specific indications, patients’ clinical features and the concomitant pharmacological management.
IS DEXMEDETOMIDINE EFFECTIVE AND SAFE FOR PROLONGED SEDATION IN CRITICALLY-ILL PEDIATRIC PATIENTS? A PROSPECTIVE MULTICENTER STUDY (PROSDEX)
Abstract
Background
Dexmedetomidine (DEX) is a selective-alpha-2-adrenergic-agonist recently authorized by Italian-Medicines-Agency for difficult sedation in pediatrics. Few data exist regarding prolonged infusions and no prospective study has systematically evaluated its efficacy so far.
Objectives
To evaluate DEX efficacy and safety for prolonged sedation in PICU.
Methods
Patients <18years receiving DEX≥24 hours in 9PICUs were included. Indications, dosages, efficacy and safety were systematically evaluated. Efficacy was defined as reduction of validated clinical-scores (Comfort-Behavior-Scale, CBS; Withdrawal-Assessment-Tool-1, WAT-1; Cornell-Assessment-of-Pediatric-Delirum, CAPD) and sparing of analgesics and sedatives. Every potential adverse-event (AE) was registered.
Results
A calculated sample-size of 163 patients (median-age 13months, IQR 4-71) were enrolled. Main indication was adjuvant for drug-sparing (42.3%). Seven-percent of patients received a loading-dose. Median infusion-duration was 108 hours (IQR 60-168) with dosages between 0.4 (IQR 0.3-0.5) and 0.8mcg/kg/h (IQR 0.6-1.2). Median time of infusion-weaning was 24 hours (IQR 5-48). Twenty-three patients (14.1%) received DEX as solo-sedation, 61% with other sedatives, 81% with other analgesics. After DEX-starting, CBS, WAT-1 and CAPD significantly reduced (p<0.001,p<0.001,p=0.027) as well as the dosages/kg/h of benzodiazepines, opioids, propofol and ketamine (p<0.001,p<0.001,p=0.001,p=0.027). Thirty-seven-percent of patients presented hemodynamic-AEs not-requiring intervention while 8.6% presented hemodynamic-AEs requiring intervention (79% dose-reduction). In multivariate models a loading-dose was associated with hemodynamic AEs (p=0.043) and the use of aminergic-inotropic-drugs was associated with severe hemodynamic-AEs (p=0.011).
Conclusion
DEX prolonged infusion assures comfort, allows sparing of opioids and benzodiazepines and helps to treat withdrawal-syndrome and delirium. AEs are mainly hemodynamic and easily reversible with dose-reduction. The loading-dose and the concomitant use of aminergic-inotropic-drugs are independent risk factors for hemodynamic-AEs.
Video on Demand
Presenter of 1 Presentation
IS DEXMEDETOMIDINE EFFECTIVE AND SAFE FOR PROLONGED SEDATION IN CRITICALLY-ILL PEDIATRIC PATIENTS? A PROSPECTIVE MULTICENTER STUDY (PROSDEX)
Abstract
Background
Dexmedetomidine (DEX) is a selective-alpha-2-adrenergic-agonist recently authorized by Italian-Medicines-Agency for difficult sedation in pediatrics. Few data exist regarding prolonged infusions and no prospective study has systematically evaluated its efficacy so far.
Objectives
To evaluate DEX efficacy and safety for prolonged sedation in PICU.
Methods
Patients <18years receiving DEX≥24 hours in 9PICUs were included. Indications, dosages, efficacy and safety were systematically evaluated. Efficacy was defined as reduction of validated clinical-scores (Comfort-Behavior-Scale, CBS; Withdrawal-Assessment-Tool-1, WAT-1; Cornell-Assessment-of-Pediatric-Delirum, CAPD) and sparing of analgesics and sedatives. Every potential adverse-event (AE) was registered.
Results
A calculated sample-size of 163 patients (median-age 13months, IQR 4-71) were enrolled. Main indication was adjuvant for drug-sparing (42.3%). Seven-percent of patients received a loading-dose. Median infusion-duration was 108 hours (IQR 60-168) with dosages between 0.4 (IQR 0.3-0.5) and 0.8mcg/kg/h (IQR 0.6-1.2). Median time of infusion-weaning was 24 hours (IQR 5-48). Twenty-three patients (14.1%) received DEX as solo-sedation, 61% with other sedatives, 81% with other analgesics. After DEX-starting, CBS, WAT-1 and CAPD significantly reduced (p<0.001,p<0.001,p=0.027) as well as the dosages/kg/h of benzodiazepines, opioids, propofol and ketamine (p<0.001,p<0.001,p=0.001,p=0.027). Thirty-seven-percent of patients presented hemodynamic-AEs not-requiring intervention while 8.6% presented hemodynamic-AEs requiring intervention (79% dose-reduction). In multivariate models a loading-dose was associated with hemodynamic AEs (p=0.043) and the use of aminergic-inotropic-drugs was associated with severe hemodynamic-AEs (p=0.011).
Conclusion
DEX prolonged infusion assures comfort, allows sparing of opioids and benzodiazepines and helps to treat withdrawal-syndrome and delirium. AEs are mainly hemodynamic and easily reversible with dose-reduction. The loading-dose and the concomitant use of aminergic-inotropic-drugs are independent risk factors for hemodynamic-AEs.