Impact of different sedation protocols and perioperative procedures on patients admitted to the intensive care unit after maxillofacial tumor surgery of the lower jaw: A retrospective study

Drs. Bashour and Balfe (Pediatrics 59(suppl):1048, June 1977) claim to have demonstrated a 19% incidence of renal anomalies in patients in the newborn period with spontaneous lung rupture. Before this figure can be accepted as fact and before decisions of investigation and/or therapy based on this incidence are initiated, certain details about their study should be noted. This retrospective study suffers primarily from the lack of information as to why the infants with spontaneous pneumothorax or pneumomediastinum were brought to the attention of the neonatal intensive care unit.

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Association of opioid exposure during intensive care unit stays with post-discharge opioid use: A retrospective study and literature review

Journal of Opioid Management ◽

10.5055/jom.2021.0685 ◽

2021 ◽

Vol 17 (6) ◽

pp. 511-516

Author(s):

Yoonsun Mo, MS, PharmD, BCPS, BCCCP ◽

John Zeibeq, MD ◽

Nabil Mesiha, MD ◽

Abou Bakar, PharmD ◽

Maram Sarsour, PharmD ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Hospital Discharge ◽

Invasive Mechanical Ventilation ◽

High Dose ◽

Opioid Use ◽

Electronic Health Record Data ◽

Icu Patients ◽

Mechanically Ventilated

Objective: To evaluate whether pain management strategies within intensive care unit (ICU) settings contribute to chronic opioid use upon hospital discharge in opioid-naive patients requiring invasive mechanical ventilation. Design: A retrospective, observational study.Setting: An 18-bed mixed ICU at a community teaching hospital located in Brooklyn, New York.Participants: This study included mechanically ventilated patients requiring continuous opioid infusion from April 25, 2017 to May 16, 2019. Patients were excluded if they received chronic opioid therapy at home or expired during this hospital admission. Eligible patients were identified using an electronic health record data query.Main outcome measure(s): The proportion of ICU patients who continued to require opioids upon ICU and hospital discharge. Results: A total of 196 ICU patients were included in this study. Of these, 22 patients were transferred to a regular floor while receiving a fentanyl transdermal patch. However, the fentanyl patch treatment was continued only for three patients (2 percent) at hospital discharge.Conclusions: This retrospective study suggested that high-dose use of opioids in mechanically ventilated, opioid-naive ICU patients was not associated with continued opioid use upon hospital discharge.

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2 Systemic glucocorticoids and bradycardia in critically ill children: a retrospective study

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.001 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e1-e1

Author(s):

Camille Maltais-Bilodeau ◽

Maryse Frenette ◽

Geneviève Morissette ◽

Dennis Bailey ◽

Karine Cloutier ◽

...

Keyword(s):

Intensive Care Unit ◽

Heart Rate ◽

Intensive Care ◽

Retrospective Study ◽

Critically Ill ◽

Medical Staff ◽

Pediatric Population ◽

Critically Ill Children ◽

Rate Variation ◽

The Impact

Abstract Background Glucocorticoids are widely used in the pediatric population. They are associated with numerous side effects including repercussions on the cardiovascular system. The impact on heart rate is not well known, but bradycardia has been reported, mostly with high doses. Objectives We described the occurrence of bradycardias and the variation of heart rate in critically ill children receiving glucocorticoids. Design/Methods We conducted a retrospective study including 1 month old to 18 year old children admitted to the Pediatric Intensive Care Unit between 2014 and 2017, who received a glucocorticoid dose equivalent to 1 to 15 mg/kg/day of prednisone. We collected data on exposition to glucocorticoids, heart rate before, during and after the exposition, and interventions from the medical staff in response to bradycardia. The primary outcome was the occurrence of bradycardia and the secondary outcomes were the magnitude of heart rate variation and the clinical management of bradycardias. Results We included 92 admissions (85 patients). The median dose of glucocorticoid used was 2.80 mg/kg/day of prednisone (2.08—3.80). We found 70 cases (76%) with at least one bradycardia. Before treatment, all patients had a mean heart rate higher than the 5th percentile for age. During exposition to glucocorticoids, 8 patients (10%, n = 83) had a median heart rate ≤ 5th percentile. We noted 46 cases of bradycardia (50%) that led to an intervention from the medical staff, but no patient had a major event associated to bradycardia. We found a significant association between bradycardia and age (estimate -0.136, 95% CI -0.207—-0.065, p < 0.001), glucocorticoid dose (estimate 4.820, 95% CI 2.048—7.592, p < 0.001) and intravenous administration (estimate 8.709, 95% CI 1.893—15.524, p = 0.012). Conclusion In our study, most children hospitalized at the intensive care unit receiving standard doses of glucocorticoid experienced bradycardia. The majority of episodes led to an intervention from the medical staff. Presence of bradycardia was associated with younger age, higher dose and IV administration of glucocorticoids.

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