Related Experiment Videos
Remifentanil for Sedation of Children With Traumatic Brain Injury
James L Hungerford1,2, Nicole O'Brien3, Melissa Moore-Clingenpeel4
11 Emory Sleep Center, Emory University, Atlanta, GA, USA.
Insights
Remifentanil effectively sedated children with traumatic brain injury (TBI) in the pediatric intensive care unit (PICU). This allowed for frequent, reliable neurologic assessments, aiding in patient management.
Area of Science:
- Pediatric Critical Care Medicine
- Neurocritical Care
- Pharmacology
Background:
- Children with traumatic brain injury (TBI) on mechanical ventilation require sedation for comfort and ventilator synchrony.
- Frequent neurologic assessments are crucial for monitoring TBI progression and guiding treatment in the pediatric intensive care unit (PICU).
- Traditional sedatives may hinder timely and accurate neurologic evaluations.
Purpose of the Study:
- To evaluate remifentanil's efficacy in sedating pediatric patients with TBI undergoing mechanical ventilation.
- To assess if remifentanil allows for frequent and reproducible neurologic examinations in this patient population.
Main Methods:
- Retrospective review of 38 pediatric patients in a tertiary care PICU over 30 months.
- Patients received continuous remifentanil infusions with intermittent boluses as needed for sedation.
- Sedation levels and time to neurologic examination after infusion pause were recorded.
Main Results:
- Remifentanil provided adequate sedation (State Behavioral Scale median 100%) in pediatric TBI patients.
- Neurologic examinations were feasible within a median of 9 minutes of pausing the infusion.
- No serious safety events were reported; 68% of patients had reassuring neurologic exams and were extubated.
Conclusions:
- Remifentanil is a suitable sedative for pediatric TBI patients requiring mechanical ventilation.
- Its rapid onset and offset facilitate reliable neurologic assessments, crucial for neurocritical care.
- This agent supports effective sedation while enabling timely clinical evaluations in the PICU.
Objective:
To determine whether remifentanil would provide adequate sedation while allowing frequent and reproducible neurologic assessments in children admitted to the pediatric intensive care unit (PICU) with traumatic brain injury (TBI) during mechanical ventilation.
Design:
Retrospective review.
Setting:
Tertiary care PICU.
Patients:
Thirty-eight patients over a 30-month period.
Measurements And Main Results:
Median age was 9 years (interquartile range [IQR] 2.25-12 years). The median Glasgow Coma Scale (GCS) was 9 (IQR: 8-10). All patients were tracheally intubated and receiving mechanical ventilation. A continuous infusion of remifentanil was started at 0.1 μg/kg/min, and bolus doses of 0.25 to 1 μg/kg were administered every 3 to 5 minutes as needed to reach the desired sedation level. Infusions were stopped at least hourly to perform neurologic examinations. The median remifentanil dose was 0.25 μg/kg/min with an IQR of 0.1 and 0.6 μg/kg/min. The maximum dose for any patient in the cohort was 2 μg/kg/min. Median duration of therapy with remifentanil was 20 hours (IQR: 8-44 hours). Adequate sedation was achieved with sedation scores (State Behavioral Scale) meeting target levels with a median value of 100% of the time (IQR: 79%-100%). Neurologic examinations were able to be performed within a median of 9 minutes (IQR: 5-14 minutes) of pausing the infusion. No serious safety events occurred. In 68% of the patients, neurologic examinations remained reassuring during remifentanil infusion, and patients were extubated. The remaining patients were transitioned to traditional sedative agents for long-term management of their traumatic injuries once the neurologic status was deemed stable.
Conclusion:
This data suggest that remifentanil is a suitable sedative agent for use in children with TBI. It provides a rapid onset of sedation with recovery that permits reliable and reproducible clinical examination.