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Retrospective observational study of chloral hydrate use in mechanically-ventilated pediatric intensive care unit
Nicholas A Ettinger1, Amy Kiskaddon2, Lindsay McNeely3
1Division of Pediatric Critical Care, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States.
Insights
Chloral hydrate (CH) use in pediatric intensive care units (PICUs) for ventilated children was studied. CH exposure was linked to longer mechanical ventilation, ICU stays, and hospital admissions, suggesting increased illness severity.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Intensive Care
Background:
- Chloral hydrate (CH) is a common pediatric procedural sedation agent.
- Limited data exists on CH use in pediatric intensive care units (PICUs).
- This study investigates CH utilization in mechanically ventilated, critically ill children.
Purpose of the Study:
- To describe the use of chloral hydrate in a PICU setting.
- To evaluate the association between CH exposure and clinical outcomes in critically ill, mechanically ventilated children.
Main Methods:
- Retrospective observational cohort study.
- Data from 3806 PICU admissions (2012-2017) of mechanically ventilated children.
- Propensity score adjustment for confounding variables.
Main Results:
- 283 admissions received CH; CH-exposed children were younger.
- CH exposure was associated with longer mechanical ventilation (5 days), ICU stay (9.4 days), and hospital admission (13.2 days).
- CH exposure correlated with increased use of high-frequency oscillatory ventilation (HFOV).
Conclusions:
- Chloral hydrate use in PICU is associated with increased illness severity and longer durations of mechanical ventilation and hospitalization.
- Further research is needed to understand the implications of CH in critically ill pediatric populations.
Abstract:
Introduction: Chloral hydrate (CH) has long been utilized as a pediatric procedural sedation agent. However, very little is published describing CH use in a pediatric intensive care unit (PICU) setting. The aim of this retrospective observational cohort study was to investigate and describe the use of CH in mechanically-ventilated, critically ill children at a large pediatric tertiary referral hospital. Methods: Data were extracted from the hospital electronic medical record and a locally maintained registry of all children admitted to the PICU between 2012 and 2017. Patients admitted to the cardiovascular ICU were not included in this review. The clinical and pharmacy data for 3806 consecutive PICU admissions of mechanically-ventilated, critically ill children were examined. Results: 283 admissions received CH during their first ICU stay. CH-exposed children were younger (16 months vs. 35 months, p < 0.001), the median total dose of CH (indexed to duration of ventilation) was 11 mg/kg/day, the median time to first CH dose was 3 days and more CH doses were administered at night (1112 vs. 958, p < 0.001). We constructed a propensity score to adjust for the differences in patients with and without CH exposure using logistic regression including variables of age, sex, diagnosis, and PRISM3 score. After adjustment, the median length of mechanical ventilation was 5 days longer in the CH-exposed group (95% Confidence Interval [CI] 4-6) compared to unexposed CH patients. Similarly, the median length of ICU duration was 9.4 days longer (95% CI 7.1-11.6) and median length of hospital admission duration was 13.2 days longer (95% CI 7.8-18.6) in CH-exposed patients compared to CH-non-exposed. After adjustment, CH-exposed patients had a 9% higher median exposure to HFOV (95% CI 3.9-14.6), but did not have higher median exposures to new tracheostomy (95% CI -0.4-2.2) or ECMO (95% CI -0.2-5.0). Discussion: As part of an extended sedation regimen in mechanically-ventilated and critically ill children, CH is associated with somewhat higher complexity of illness and longer ICU durations.
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