Nurse-driven pediatric analgesia and sedation protocol reduces withdrawal symptoms in critically ill medical pediatric patients

2015 ◽  
Vol 25 (8) ◽  
pp. 786-794 ◽  
Author(s):  
Felix Neunhoeffer ◽  
Matthias Kumpf ◽  
Hanna Renk ◽  
Malte Hanelt ◽  
Nicole Berneck ◽  
...  
Keyword(s):  
Critically Ill ◽  
Pediatric Patients ◽  
Withdrawal Symptoms ◽  
Sedation Protocol ◽  
Pediatric Analgesia

scholarly journals Evaluating the Transition From Dexmedetomidine to Clonidine for the Prevention of Withdrawal in Critically Ill Pediatric Patients

2020 ◽  
Vol 25 (2) ◽  
pp. 104-110 ◽  
Author(s):  
Michelle M. Lee ◽  
Karen Caylor ◽  
Nicole Gockenbach
Keyword(s):  
Critically Ill ◽  
Cardiovascular Events ◽  
Pediatric Patients ◽  
Cardiovascular Effects ◽  
Descriptive Study ◽  
Withdrawal Symptoms ◽  
Average Dose ◽  
Median Dose ◽  
Park Ridge ◽  
Dexmedetomidine Infusion

OBJECTIVES To evaluate clonidine for preventing withdrawal from dexmedetomidine infusions and describe the incidence of withdrawal symptoms and adverse cardiovascular effects in critically ill pediatric patients. METHODS Retrospective, descriptive study of patients in Advocate Children's Hospital-Park Ridge PICU who received dexmedetomidine infusion for ≥72 hours, followed by clonidine for ≥48 hours, between January 1, 2015, and August 31, 2017. RESULTS Thirty-eight patients (median age 4.3 years; IQR, 2–11.5) received 39 dexmedetomidine courses. The median duration of dexmedetomidine exposure was 7.6 days (IQR, 5–11.5) at an average dose of 1 mcg/kg/hr. The median dose of clonidine at initiation was 8.3 mcg/kg/day (for <50 kg) and 4.1 mcg/kg/day (for ≥50 kg). The most common oral administration frequency was every 8 hours. Dexmedetomidine infusions for 7 days or longer and a higher dexmedetomidine dose 24 hours prior to clonidine transition both correlated with increased initial clonidine doses. Fourteen patients (37%) had at least 1 WAT-1 score of ≥3 during the transition between dexmedetomidine and clonidine, with 7 (18%) requiring an increase in sedation. Adverse cardiovascular events were possibly attributable to dexmedetomidine and/or clonidine in 4 patients. CONCLUSIONS Patients receiving prolonged infusions of dexmedetomidine may transition to clonidine to help prevent withdrawal symptoms. Duration of dexmedetomidine infusion of 7 days or longer and higher average dexmedetomidine dose 24 hours prior to the transition are important considerations when determining the initial clonidine dose. Transition from dexmedetomidine to clonidine was found to be safe and efficacious in our patients, with minimal adverse effects.

Sedation Protocol for Critically Ill Pediatric Patients

JAMA ◽  
2015 ◽  
Vol 313 (17) ◽  
pp. 1754
Author(s):  
Kenneth E. Remy
Keyword(s):  
Critically Ill ◽  
Pediatric Patients ◽  
Sedation Protocol

scholarly journals Sedation Protocol for Critically Ill Pediatric Patients—Reply

JAMA ◽  
2015 ◽  
Vol 313 (17) ◽  
pp. 1754 ◽  
Author(s):  
Martha A. Q. Curley ◽  
David Wypij ◽  
Michael A. Matthay
Keyword(s):  
Critically Ill ◽  
Pediatric Patients ◽  
Sedation Protocol

Analgesia and Sedation Protocol for Mechanically Ventilated Postsurgical Children Reduces Benzodiazepines and Withdrawal Symptoms—But Not in All Patients

2016 ◽  
Vol 27 (03) ◽  
pp. 255-262 ◽  
Author(s):  
Guido Seitz ◽  
Andreas Schmidt ◽  
Hanna Renk ◽  
Matthias Kumpf ◽  
Frank Fideler ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Solid Organ Transplantation ◽  
Pediatric Intensive Care ◽  
Drug Dosage ◽  
Withdrawal Symptoms ◽  
Solid Organ ◽  
Two Phase ◽  
Mechanically Ventilated ◽  
Sedation Protocol ◽  
Pediatric Analgesia

Background We demonstrated recently that the implementation of a nurse-driven analgesia and sedation protocol (pediatric analgesia and sedation protocol [pASP]) for mechanically ventilated nonpostsurgical patients reduces the total dose of benzodiazepines and the withdrawal symptoms significantly. It has not been investigated if these results can also be expected in the group of patients undergoing surgery. Objectives To evaluate the effects of the pASP in mechanically ventilated postsurgical children regarding drug dosage, duration of mechanical ventilation, length of stay, and rate of withdrawal symptoms. Methods This is a two-phase prospective observational control study. The preimplementation group was managed by the physician's order and the postimplementation group was managed with the pASP including COMFORT-B, nurse interpretation of sedation, and Sophia observation withdrawal symptoms scale scoring. Measurements and Main Results One hundred and sixteen patients were included before and one hundred and ten patients after implementation. The pASP had no effect on length of pediatric intensive care unit stay or duration of mechanical ventilation. The protocol reduced total (5.0 mg/kg [0.5–58.0] vs 4.0 mg/kg [0.0–47.0]; p = 0.021) and daily doses (4.4 mg/kg/d [1.1–33.9] vs 2.9 mg/kg/d [0.0–9.9]; p < 0.001) of benzodiazepines significantly. No difference was observed in total and daily doses of opioids (5.0 mg/kg [0.1–67.0] vs 3.0 mg/kg [0.1–71.0]; p = 0.81) and (0.7 mg/kg/d [0.0–7.0] vs. 0.8 mg/kg/d [0.0–3.7]; p = 0.35), respectively. Rate of withdrawal symptoms was significantly lower after implementation (35.3 vs 20.0%; p = 0.01), but not in patients after solid organ transplantation or oncological patients. Conclusion The nurse-driven analgesia and sedation protocol is an effective procedure to reduce the total doses of benzodiazepines and occurrence of withdrawal symptoms in postsurgical children, which are naïve to opioids or benzodiazepines.

Fate of Central Venous Catheters Used for Acute Extracorporeal Treatment in Critically Ill Pediatric Patients: A Single Center Experience

2016 ◽  
Vol 20 (3) ◽  
pp. 308-311
Author(s):  
Rina R Rus ◽  
Vladimir Premru ◽  
Gregor Novljan ◽  
Mojca Grošelj-Grenc ◽  
Rafael Ponikvar
Keyword(s):  
Critically Ill ◽  
Pediatric Patients ◽  
Central Venous Catheters ◽  
Single Center ◽  
Central Venous ◽  
Extracorporeal Treatment ◽  
Single Center Experience

scholarly journals The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients

2008 ◽  
Vol 9 (5) ◽  
pp. 490-496 ◽  
Author(s):  
Angela T. Wratney ◽  
Daniel Kelly Benjamin ◽  
Anthony D. Slonim ◽  
James He ◽  
Donna S. Hamel ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Critically Ill ◽  
Pediatric Patients ◽  
Air Leak ◽  
Leak Test ◽  
Air Leak Test ◽  
Extubation Outcome
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