Patterns of Sedation Weaning in Critically Ill Children Recovering From Acute Respiratory Failure

Pediatr Crit Care Med. 2016 Jan;17(1):19-29. doi: 10.1097/PCC.0000000000000572.

Abstract

Objective: To characterize sedation weaning patterns in typical practice settings among children recovering from critical illness.

Design: A descriptive secondary analysis of data that were prospectively collected during the prerandomization phase (January to July 2009) of a clinical trial of sedation management.

Setting: Twenty-two PICUs across the United States.

Patients: The sample included 145 patients, aged 2 weeks to 17 years, mechanically ventilated for acute respiratory failure who received at least five consecutive days of opioid exposure.

Interventions: None.

Measurements and main results: Group comparisons were made between patients with an intermittent weaning pattern, defined as a 20% or greater increase in daily opioid dose after the start of weaning, and the remaining patients defined as having a steady weaning pattern. Demographic and clinical characteristics, tolerance to sedatives, and iatrogenic withdrawal symptoms were evaluated. Sixty-six patients (46%) were intermittently weaned; 79 patients were steadily weaned. Prior to weaning, intermittently weaned patients received higher peak and cumulative doses and longer exposures to opioids and benzodiazepines, demonstrated more sedative tolerance (58% vs 41%), and received more chloral hydrate and barbiturates compared with steadily weaned patients. During weaning, intermittently weaned patients assessed for withdrawal had a higher incidence of Withdrawal Assessment Tool-version 1 scores of greater than or equal to 3 (85% vs 46%) and received more sedative classes compared with steadily weaned patients.

Conclusions: This study characterizes sedative administration practices for pediatric patients prior to and during weaning from sedation after critical illness. It provides a novel methodology for describing weaning in an at-risk pediatric population that may be helpful in future research on weaning strategies to prevent iatrogenic withdrawal syndrome.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Analgesics, Opioid / administration & dosage
  • Benzodiazepines / administration & dosage
  • Child
  • Child, Preschool
  • Critical Illness
  • Drug Tolerance
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric / organization & administration*
  • Male
  • Prospective Studies
  • Racial Groups
  • Respiration, Artificial / methods
  • Respiratory Distress Syndrome / therapy*
  • Respiratory Distress Syndrome, Newborn / therapy*
  • Sex Factors
  • Substance Withdrawal Syndrome / prevention & control*
  • Time Factors

Substances

  • Analgesics, Opioid
  • Hypnotics and Sedatives
  • Benzodiazepines