Patterns of Sedation Weaning in Critically Ill Children Recovering From Acute Respiratory Failure

Kaitlin M. Best, Lisa A. Asaro, Linda S. Franck, David Wypij, Martha A Q Curley, Geoffrey L. Allen, Judy A. Ascenzi, Scot T. Bateman, Santiago Borasino, Ira M. Cheifetz, Allison S. Cowl, E. Vincent S Faustino, Lori D. Fineman, Heidi R. Flori, Mary Jo C Grant, James H. Hertzog, Larissa Hutchins, Aileen L. Kirby, JoAnne E Natale, Phineas P. OrenNagendra Polavarapu, Thomas P. Shanley, Shari Simone, Lauren R. Sorce, Michele A Vander Heyden

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Objective: To characterize sedation weaning patterns in typical practice settings among children recovering from critical illness. Design: A descriptive secondary analysis of data that were prospectively collected during the prerandomization phase (January to July 2009) of a clinical trial of sedation management. Setting: Twenty-two PICUs across the United States. Patients: The sample included 145 patients, aged 2 weeks to 17 years, mechanically ventilated for acute respiratory failure who received at least five consecutive days of opioid exposure. Interventions: None. Measurements and Main Results: Group comparisons were made between patients with an intermittent weaning pattern, defined as a 20% or greater increase in daily opioid dose after the start of weaning, and the remaining patients defined as having a steady weaning pattern. Demographic and clinical characteristics, tolerance to sedatives, and iatrogenic withdrawal symptoms were evaluated. Sixty-six patients (46%) were intermittently weaned; 79 patients were steadily weaned. Prior to weaning, intermittently weaned patients received higher peak and cumulative doses and longer exposures to opioids and benzodiazepines, demonstrated more sedative tolerance (58% vs 41%), and received more chloral hydrate and barbiturates compared with steadily weaned patients. During weaning, intermittently weaned patients assessed for withdrawal had a higher incidence of Withdrawal Assessment Tool-version 1 scores of greater than or equal to 3 (85% vs 46%) and received more sedative classes compared with steadily weaned patients. Conclusions: This study characterizes sedative administration practices for pediatric patients prior to and during weaning from sedation after critical illness. It provides a novel methodology for describing weaning in an at-risk pediatric population that may be helpful in future research on weaning strategies to prevent iatrogenic withdrawal syndrome.

Original languageEnglish (US)
Pages (from-to)19-29
Number of pages11
JournalPediatric Critical Care Medicine
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • benzodiazepine
  • opioid
  • Randomized Evaluation of Sedation Titration for Respiratory Failure
  • sedation
  • weaning
  • withdrawal assessment
  • Withdrawal Assessment Tool-version 1

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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