Patterns of Sedation Weaning in Critically Ill Children Recovering From Acute Respiratory Failure.
OBJECTIVE
To characterize sedation weaning patterns in typical practice settings among children recovering from critical illness.


METHODS
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.


METHODS
Twenty-two PICUs across the United States.


METHODS
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.


METHODS
None.


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.
1University of Pennsylvania, Philadelphia, PA. 2Department of Cardiology, Boston Children's Hospital, Boston, MA. 3Department of Family Health Care Nursing, University of California, San Francisco, CA. 4Department of Pediatrics, Harvard Medical School, Boston, MA. 5Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA. 6Department of Family and Community Health in the School of Nursing, and the Department of Anesthesia and Critical Care Medicine in the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 7Critical Care/Cardiovascular Nursing Program, Boston Children's Hospital, Boston, MA.
Kaitlin M
KM
Best
Lisa A
LA
Asaro
Linda S
LS
Franck
David
D
Wypij
Martha A Q
MA
Curley
D000293:Adolescent; D000367:Age Factors; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001569:Benzodiazepines / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D008297:Male; D011446:Prospective Studies; D044469:Racial Groups; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012737:Sex Factors; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*; D013997:Time Factors
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines