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Published on: January 16, 2019

Randomized controlled trial of daily interruption of sedatives in critically ill children

Carin W M Verlaat1, Ger P Heesen, Nienke J Vet

  • 1Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Paediatric Anaesthesia
|August 29, 2013
PubMed

Insights

Daily interruption of sedatives in critically ill children is feasible and reduces sedative use. This approach leads to earlier extubation and shorter pediatric intensive care unit stays.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Intensive Care Unit Management

Background:

  • Sedation is commonly used in mechanically ventilated children.
  • Prolonged sedation can lead to adverse effects and longer intensive care unit (ICU) stays.

Purpose of the Study:

  • To evaluate the feasibility of daily interruption of sedative medications in critically ill pediatric patients.
  • To assess the impact of daily sedative interruption on sedative consumption, mechanical ventilation duration, and ICU length of stay.

Main Methods:

  • A prospective randomized controlled open-label trial was conducted in a pediatric intensive care unit.
  • 30 mechanically ventilated children (0-12 years) were randomized to daily sedative interruption or standard care.
  • Sedatives were stopped daily and restarted if a COMFORT-behavior score reached ≥17 in the intervention group.

Main Results:

  • The intervention group showed significantly lower midazolam and morphine use compared to the control group.
  • Duration of mechanical ventilation was significantly shorter in the daily interruption group (4 days vs. 9 days).
  • Length of stay in the pediatric intensive care unit was significantly reduced in the intervention group (6 days vs. 10 days).

Conclusions:

  • Daily interruption of sedatives is a feasible strategy in critically ill children.
  • This intervention leads to decreased sedative requirements.
  • Early extubation and shorter pediatric intensive care unit length of stay are associated with daily sedative interruption.
Abstract

Keywords:
COMFORT scorechildrencritical illnessinterruptionsedatives

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