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Sedation and neurodevelopmental outcomes in PICU: Identification of study groups
Davinia E Withington1, Razaz Mujallid2, Zainab Al Sabaa1
1Department of Anesthesia, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
Insights
Anesthetic and sedative agents may harm infant brain development. This study found comparable groups of ventilated infants, with and without sedation, suitable for neurodevelopmental outcomes research.
Area of Science:
- Neonatal critical care
- Pediatric neurodevelopment
- Pharmacology
Background:
- Exposure to anesthetic and sedative agents, even for short durations, may negatively impact developing infant brains.
- Sedative agents are crucial for managing critically ill infants, often requiring prolonged use.
- Identifying comparable patient groups is essential for studying the long-term neurodevelopmental effects of sedation in infants.
Purpose of the Study:
- To determine the feasibility of identifying two comparable groups of infants: one receiving sedation and one not.
- To lay the groundwork for a long-term neurodevelopmental follow-up study in critically ill infants.
Main Methods:
- Infants with respiratory issues on noninvasive ventilation without sedation (Group C) or intubated and ventilated with sedation (Group S) were identified via chart review.
- Exclusion criteria included neurological disease, extreme prematurity, congenital cardiac disease, and genetic anomalies.
- Pediatric severity of illness scores (PRISM and PELOD) were extracted and compared between groups, both absolutely and by risk strata.
Main Results:
- Group S comprised 33 patients, and Group C included 39 patients.
- Significant differences were observed in absolute PRISM and PELOD scores between the groups.
- No significant differences were found between groups when stratified by PRISM risk (greater/less than 5 or 10).
Conclusions:
- Randomizing infants to sedation or no sedation for neurodevelopmental outcome studies is not feasible.
- The identified groups of infants (sedated vs. non-sedated) are comparable and suitable for enrollment as exposed and control subjects in an outcomes study.
Background/Aims:
As little as 30 minutes of exposure to anesthetic and sedative agents may adversely affect the developing brain. Safe, humane management of critically ill infants requires the use of sedative agents, often for prolonged periods. We sought to identify two comparable groups of critical care patients who did or did not receive sedatives, with the aim of designing a long-term neurodevelopment follow-up study. This feasibility study aimed to determine if two comparable groups could be found.
Methods:
Infants with respiratory diagnoses having noninvasive ventilation without sedation (Group C) or intubation and ventilation with sedation (Group S) were identified by chart review. Charts of patients fulfilling the above inclusion criteria were searched for exclusion criteria including neurological disease, extreme prematurity, congenital cardiac disease, and genetic anomalies. Data were extracted to score pediatric severity of illness scores (PRISM and PELOD) for each patient. These scores were then compared using the absolute scores and by risk strata.
Results:
Group S included 33 patients and Group C had 39. The absolute PRISM and PELOD scores were different between groups. Comparing the groups in three risk strata (PRISM greater or less than 5 or 10), there were no significant differences between groups.
Conclusion:
It is not possible to randomize infants to sedation or no sedation to investigate neurodevelopmental outcomes. This phase of the project aimed to determine the comparability of two groups of PICU patients. These findings indicate that these groups could be enrolled as exposed and control subjects in an outcomes study.
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