Evidence map›Paper›PMID 39932727›Full record

Trial reportCritical care explorations2025

Association of Obesity With Sedative Dosing, Sedative Response, and Clinical Outcomes in Mechanically Ventilated Critically Ill Children.

Shan L Ward, Onella S Dawkins-Henry, Lisa A Asaro, David Wypij, Martha A Q Curley, Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators

Registry-linked trialAbstract readRandomized Controlled TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care explorations, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00814099 (Sedation Management in Pediatric Patients With Acute Respiratory Failure), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing 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.

NCT00814099 nacompletednot on this map

Sedation Management in Pediatric Patients With Acute Respiratory Failure

TypeinterventionalSponsorUniversity of PennsylvaniaRan2009 to 2013Enrolled2,449ConditionsRespiratory Insufficiency, Respiratory Distress Syndrome, Newborn, Lung DiseasesArmsTeam approach to sedation management, Usual approach to sedation management
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
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

6 authors.

Shan L WardDepartment of Pediatrics, Division of Critical Care, UCSF Benioff Children's Hospitals, San Francisco and Oakland, CA.ORCID 0000-0002-1375-6240
Onella S Dawkins-HenryDepartment of Cardiology, Boston Children's Hospital, Boston, MA.
Lisa A AsaroDepartment of Cardiology, Boston Children's Hospital, Boston, MA.
David WypijDepartment of Cardiology, Boston Children's Hospital, Boston, MA.
Martha A Q CurleyDepartment of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.
Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators

Funding

Sedation Management in Pediatric Patients with Acute Respiratory FailureU01HL086622 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI CURLEY, MARTHA AQ · 2008 to 2013
$10.0M
Sedation Management in Pediatric Patients with Acute Respiratory Failure (DCC)U01HL086649 · NHLBI · BOSTON CHILDREN'S HOSPITAL · PI WYPIJ, DAVID · 2008 to 2012
$2.0M
NHLBI NIH HHS U01 HL086622NHLBI NIH HHS U01 HL086649
6 · The paper itself

Abstract

objectivesThis study aimed to investigate the impact of obesity on the use of analgesics and sedatives, rates of iatrogenic withdrawal syndrome (IWS), and outcomes in mechanically ventilated pediatric patients. Additionally, it sought to assess whether a nurse-implemented sedation protocol would be equally effective for children with and without obesity.

designSecondary analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) pediatric multicenter clinical trial.

settingThirty-one U.S. PICUs. PATIENTS: Children 1-17 years old, categorized as with or without obesity according to World Health Organization and Centers for Disease Control and Prevention criteria.

interventionsNone. MEASUREMENTS AND MAIN

resultsThe study assessed various factors including medication exposure, adequacy of pain and sedation management, IWS rates, and clinical outcomes. Obesity occurred in 22% of patients. Obesity did not influence choice of opiate, but it led to extended exposure to these medications. There were no differences in dosing per kilogram of admission weight, resulting in significantly higher daily and cumulative doses in those with obesity. In the protocolized sedation arm, patients with obesity received significantly higher median opiate doses compared with the nonobesity protocolized sedation group. IWS rates did not differ; however, protocolized sedation obesity patients experienced more instances of inadequate sedation, longer time to extubation readiness, longer duration of mechanical ventilation and PICU stay, and higher 28-day in-hospital mortality than the protocolized sedation nonobesity group. These weight-based differences were not noted in the usual care arm.

conclusionsThis study underscores the significance of accounting for body habitus when selecting and dosing opiates in children with acute respiratory failure. Obesity had substantial impact on medication exposure and clinical outcomes, particularly within a structured, protocolized sedation regimen. Further research is warranted to explore the intricate relationship between medication dosing and clinical outcomes in children with obesity.

Indexed as

Critical IllnessHypnotics and SedativesObesityRespiration, ArtificialAdolescentAnalgesics, OpioidChildChild, PreschoolFemaleHumansInfantIntensive Care Units, PediatricMaleRespiratory InsufficiencySubstance Withdrawal SyndromeAnalgesics, OpioidHypnotics and Sedatives

Identifiers

PMID39932727
PMCPMC11813009

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Registered trials

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.