Evidence map›Paper›PMID 32362669›Full record

ArticleThe Canadian journal of hospital pharmacy

Sedative Medications for Critically Ill Children during and after Mechanical Ventilation: A Retrospective Observational Study.

Deanna Caldwell, Jonathan Wong, Mark Duffett

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Article in The Canadian journal of hospital pharmacy. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. The Canadian journal of hospital pharmacy
    Article
  5. Medication Safety-A Global Health Priority.The Canadian journal of hospital pharmacy
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Deanna Caldwell, PharmD, ACPR, RPh, was, at the time of this study, a pharmacy resident at McMaster Children's Hospital, Hamilton, Ontario. She is now with the Department of Pharmacy, London Health Sciences, London, Ontario, BScPharm, PharmD, ACPR, RPh, is with the Department of Pharmacy, McMaster Children's Hospital, Hamilton, Ontario, BSc(Pharm), MSc, PhD, ACPR, RPh, is with the Department of Pediatrics, McMaster University, and the Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario.
Jonathan Wong, PharmD, ACPR, RPh, was, at the time of this study, a pharmacy resident at McMaster Children's Hospital, Hamilton, Ontario. She is now with the Department of Pharmacy, London Health Sciences, London, Ontario, BScPharm, PharmD, ACPR, RPh, is with the Department of Pharmacy, McMaster Children's Hospital, Hamilton, Ontario, BSc(Pharm), MSc, PhD, ACPR, RPh, is with the Department of Pediatrics, McMaster University, and the Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario.
Mark Duffett, PharmD, ACPR, RPh, was, at the time of this study, a pharmacy resident at McMaster Children's Hospital, Hamilton, Ontario. She is now with the Department of Pharmacy, London Health Sciences, London, Ontario, BScPharm, PharmD, ACPR, RPh, is with the Department of Pharmacy, McMaster Children's Hospital, Hamilton, Ontario, BSc(Pharm), MSc, PhD, ACPR, RPh, is with the Department of Pediatrics, McMaster University, and the Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundProviding safe and effective sedation to critically ill children is challenging. The assessment, prevention, and treatment of symptoms of iatrogenic withdrawal are critical aspects of sedation practice.

objectiveTo describe the use of sedative medications in critically ill children at McMaster Children's Hospital.

methodsThis retrospective observational study included children admitted over a 12-month period who survived their illness and who received sedation and at least 48 h of invasive ventilation. We collected data from the time of admission to the pediatric intensive care unit to 3 days after discontinuation of sedation.

resultsWe included 67 children. The median age was 1.6 (interquartile range [IQR] 0.2-6.2) years, and respiratory illnesses were the most common reason for admission (41 [61%]). The children received invasive ventilation for a median of 7 (IQR 4-11) days and sedation for a median of 12 (IQR 6-20) days. Sixty-six children (99%) received an opioid, and all received a benzodiazepine, with median cumulative doses of 14 (IQR 5-27) mg/kg morphine equivalents and 15 (IQR 6-32) mg/kg midazolam equivalents. Dexmedetomidine was given to 31 children (46%), for a median of 8 (IQR 4-12) days. Most children (67%) received sedation after extubation (median duration 7 [IQR 4-14] days). In addition, 32 children (48%) continued to receive sedative medications after transfer to the ward, for a median of 6 (IQR 4-13) days. Forty-two children (63%) had at least one Withdrawal Assessment Tool-1 (WAT-1) score indicative of iatrogenic withdrawal. Children who experienced withdrawal were exposed to more opioids and more benzodiazepines, both per day and overall, and for longer periods.

conclusionsThe children in this study were exposed to multiple sedatives, and many continued to receive these medications for an extended period after discontinuation of mechanical ventilation. Iatrogenic withdrawal was common and represents an important opportunity to improve children's recovery after critical illness.

Indexed as

pediatricssedationwithdrawal

Identifiers

PMID32362669
PMCPMC7182370

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.