Midazolam infusion in pediatric patients with burns who are undergoing mechanical ventilation.
Adequate sedation is an integral component of mechanical ventilation. To document the safety and efficacy of midazolam infusion in pediatric patients with burns who were undergoing mechanical ventilation, a retrospective review was done of all patients requiring mechanical ventilation over a 22-month period. Twenty-four acutely burned pediatric patients required mechanical ventilation. The average age was 6.4 years (range 7 months to 12 years), and the average burn size was 50% of the body surface (range 40% to 95%). Midazolam infusion was initiated at an average dose of 0.045 mg/kg/hr (range 0.01 to 0.09 mg/kg/hr). The maximum dose administered averaged 0.11 mg/kg/hr (range 0.04 to 0.35 mg/kg/hr). The duration of infusion averaged 16.5 days (range 4 to 56 days). All patients received simultaneous infusions of morphine sulfate. Midazolam infusion was titrated to achieve a diminished narcotic requirement, decreased anxiety, and better tolerance of dressing changes. No hypotension or problems weaning from mechanical ventilation were seen. Two (8.3%) children experienced reversible neurologic abnormalities attributed to midazolam infusion but made full neurologic recoveries. In conclusion, our experience with midazolam infusion in pediatric patients with burns who were undergoing mechanical ventilation is favorable and supports its continued use.
Sheridan
R L
RL
Shriners Burns Institute, Boston, MA 02114.
McEttrick
M
M
Bacha
G
G
Stoddard
F
F
Tompkins
R G
RG
D001007:Anxiety / Q000188:drug therapy*; D002056:Burns / Q000523:psychology / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D009020:Morphine / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors
D009020:Morphine; D008874:Midazolam