Factors Influencing Analgesic Use During Transport of Intubated Pediatric Patients

Critically ill children undergo painful procedures during resuscitation and stabilization before and during interfacility transport. The literature supporting pain management in this unique environment focuses predominantly on isolated traumatic injuries. Timely administration of analgesia can improve patient well-being by attenuating stress responses and reducing severe adverse events. To determine the prevalence of analgesia administration among pediatric patients undergoing mechanical ventilation during transport and to identify associated factors.

We conducted a retrospective cohort study using electronic patient records from a large critical care transport system in North America, between 2014 and 2018. We included sequential pediatric patients who were intubated and mechanically ventilated. We examined analgesia administration (with opioids or ketamine) administered by paramedics. Adverse events were examined in relation to analgesia administration. Multivariable logistic regression identified factors associated with in-transport analgesia administration.

Of 903 patients (median age 9.1 years), 770 (85.3%) received analgesia during transport, with 83.3% receiving opioids or ketamine. Patients without opiate or ketamine analgesia during transport experienced higher rates of hypotension (38.4% vs. 26.9%) and hypoxemia (29.1% vs. 22.1%). Factors significantly associated with opiate or ketamine use included the reason for transport, transport duration, paralytic use, and pre-transport opiate or ketamine administration. Patients with comorbidities were less likely to receive analgesia during transport.

This study's findings highlight the need for improved pain evaluation in caring for mechanically ventilated pediatric patients during transport. Factors such as transport, duration, the reason for transport, pre-transport opiate or ketamine administration, and paralytics increase the likelihood of analgesia administration. At the same time, the presence of comorbidities decreases the likelihood. The study underscores the importance of improved documentation of pain to inform analgesic choices and administration with the ultimate goal of reducing adverse events.