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Quality of sedation during mechanical ventilation
S D Playfor1, D A Thomas, I Choonara
1Paediatric Intensive Care Unit, Queens Medical Centre, Nottingham NG7 2UH, UK.
Insights
Sedation quality in ventilated pediatric intensive care unit (PICU) patients was assessed. A combined intravenous and oral sedation regimen proved satisfactory for most children, even those on neuromuscular blocking agents.
Area of Science:
- Pediatric Intensive Care
- Anesthesiology
- Pharmacology
Background:
- Effective sedation is crucial for ventilated patients in the pediatric intensive care unit (PICU).
- Assessing sedation quality, especially in patients receiving neuromuscular blocking agents, presents unique challenges.
Purpose of the Study:
- To evaluate the quality of sedation in mechanically ventilated children within a general PICU setting.
- To assess sedation effectiveness in patients receiving neuromuscular blocking agents.
Main Methods:
- Utilized an arousability scale based on response to tracheal suction to determine sedation levels in 28 ventilated children.
- Compared observed sedation levels against a predetermined desired sedation target.
- Conducted 81 assessments, including 32 in 15 children after temporary discontinuation of neuromuscular blocking agents.
Main Results:
- Overall, 90% of the 81 sedation assessments were deemed satisfactory.
- In patients temporarily off neuromuscular blocking agents, 97% of 32 assessments met satisfactory sedation levels.
- Continuous intravenous midazolam and morphine, supplemented with oral chloral hydrate and antihistamines, achieved good sedation.
Conclusions:
- A continuous intravenous midazolam and morphine regimen, with supplementary oral agents, provides satisfactory sedation for most ventilated PICU patients.
- This sedation strategy is effective even in pediatric patients requiring neuromuscular blocking agents.
- The study supports the use of this multimodal sedation approach for improving patient comfort and care in the PICU.
Abstract:
The aim of the study was to determine the quality of sedation in ventilated patients on a general paediatric intensive care unit (PICU), including those treated with infusions of neuromuscular blocking agents. Twenty-eight ventilated children on a PICU had their level of sedation determined using an arousability scale dependent upon the response to tracheal suction. Observed levels of sedation were then compared to a predetermined desired level of sedation. A total of 81 assessments were performed and 90% were considered satisfactory. Thirty-two of these assessments were performed in 15 children following the temporary discontinuation of infusions of neuromuscular blocking agents; 97% of these assessments were considered satisfactory. A regime of continuous intravenous midazolam and morphine with additional oral sedation using chloral hydrate and antihistamines when required provides a satisfactory level of sedation for the majority of children ventilated on a PICU, including those treated with infusions of neuromuscular blocking agents.