title: A retrospective study of sedation and analgesic requirements of pediatric patients on extracorporeal membrane oxygenation (ECMO) from a single-center experience.
abstract: BACKGROUND
  The purpose of this study is to describe the sedative and analgesic requirements identifying factors associated with medication escalation in neonates and children supported on ECMO.
  
  
  METHODS
  Observational retrospective cohort study in a tertiary pediatric intensive care unit from June 2009 to June 2013.
  
  
  RESULTS
  One hundred and sixty patients were included in the study. Fentanyl and midazolam were the first line agents used while on ECMO. Higher opiate requirements were associated with younger age (p=0.01), thoracic cannulation (p=0.002), the use of dexmedetomidine (p=0.007) and prolonged use of muscle relaxants (p=0.03). Higher benzodiazepine requirements were associated with younger age (p=0.01), respiratory failure (p=0.02) and the use of second line agents (p=0.002). One third of the patients required second line agents as adjuvants for comfort without a decrease in opiate and/or benzodiazepine requirements.
  
  
  CONCLUSIONS
  Providing comfort to subpopulations of pediatric ECMO patients seems to be more challenging. The use of second line agents did not improve comfort in our cohort. Prospective studies are required to optimize analgesia and sedation management in children on ECMO.
authors.affiliation: 1 Department of Pediatrics, Critical Care Division, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Pilar
authors.initials: P
authors.lastname: Anton-Martin
authors.affiliation: 2 Department of Pediatrics, Critical Care Division, University of Texas Health Science Center at Houston, Texas, USA.
authors.forename: Vinai
authors.initials: V
authors.lastname: Modem
authors.affiliation: 3 Department of Respiratory Therapy, Children's Health Dallas, Dallas, Texas, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Taylor
authors.affiliation: 3 Department of Respiratory Therapy, Children's Health Dallas, Dallas, Texas, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Potter
authors.affiliation: 1 Department of Pediatrics, Critical Care Division, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Darnell-Bowens
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008874:Midazolam / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D008874:Midazolam; D005283:Fentanyl
keywords: analgesia; benzodiazepines; extracorporeal membrane oxygenation; opiates; sedation; withdrawal