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Midazolam infusion in pediatric patients with burns who are undergoing mechanical ventilation
R L Sheridan1, M McEttrick, G Bacha
1Shriners Burns Institute, Boston, MA 02114.
Insights
Midazolam infusion effectively sedated pediatric burn patients on mechanical ventilation, reducing narcotic needs and improving tolerance. While some experienced temporary neurological issues, overall safety and efficacy were favorable for this critical care setting.
Area of Science:
- Pediatric Critical Care
- Burn Management
- Pharmacology
Background:
- Adequate sedation is crucial for pediatric patients requiring mechanical ventilation.
- Burn injuries in children often necessitate prolonged mechanical ventilation and intensive sedation.
- Midazolam is a commonly used sedative, but its safety and efficacy in this specific population require documentation.
Purpose of the Study:
- To evaluate the safety and efficacy of midazolam infusion in pediatric patients with severe burns requiring mechanical ventilation.
- To assess the impact of midazolam on sedation requirements, patient comfort, and weaning from mechanical ventilation.
- To identify any adverse events associated with midazolam use in this cohort.
Main Methods:
- A retrospective review of 24 pediatric patients with acute burns requiring mechanical ventilation over 22 months.
- Analysis of midazolam infusion doses, duration, and concurrent morphine sulfate use.
- Assessment of clinical outcomes including sedation effectiveness, hemodynamic stability, and mechanical ventilation weaning.
Main Results:
- Midazolam infusion was initiated at an average dose of 0.045 mg/kg/hr and titrated as needed.
- Patients showed diminished narcotic requirements, decreased anxiety, and better tolerance to procedures.
- No hypotension or difficulties weaning from mechanical ventilation were observed; two patients had reversible neurologic abnormalities.
Conclusions:
- Midazolam infusion appears to be a safe and effective sedative agent for pediatric burn patients on mechanical ventilation.
- It helps manage sedation, reduce opioid use, and improve patient tolerance to care.
- Further use of midazolam in this population is supported by these findings, with careful monitoring for potential neurological side effects.
Abstract:
Adequate sedation is an integral component of mechanical ventilation. To document the safety and efficacy of midazolam infusion in pediatric patients with burns who were undergoing mechanical ventilation, a retrospective review was done of all patients requiring mechanical ventilation over a 22-month period. Twenty-four acutely burned pediatric patients required mechanical ventilation. The average age was 6.4 years (range 7 months to 12 years), and the average burn size was 50% of the body surface (range 40% to 95%). Midazolam infusion was initiated at an average dose of 0.045 mg/kg/hr (range 0.01 to 0.09 mg/kg/hr). The maximum dose administered averaged 0.11 mg/kg/hr (range 0.04 to 0.35 mg/kg/hr). The duration of infusion averaged 16.5 days (range 4 to 56 days). All patients received simultaneous infusions of morphine sulfate. Midazolam infusion was titrated to achieve a diminished narcotic requirement, decreased anxiety, and better tolerance of dressing changes. No hypotension or problems weaning from mechanical ventilation were seen. Two (8.3%) children experienced reversible neurologic abnormalities attributed to midazolam infusion but made full neurologic recoveries. In conclusion, our experience with midazolam infusion in pediatric patients with burns who were undergoing mechanical ventilation is favorable and supports its continued use.