Observational studyNeurocritical care2025
Analgesia, Sedation, and Neuromuscular Blockade in Pediatric Severe Traumatic Brain Injury: Secondary Analysis of the "Approaches and Decisions in Acute Pediatric TBI Trial" (ADAPT).
Observational study in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04077411 (Approaches and Decisions for Acute Pediatric TBI), which is not on this map. Not yet cited in PubMed.
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.
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.
Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
backgroundSedative, analgesia, and neuromuscular blocking (NMB) medications may be necessary in the acute management of pediatric severe traumatic brain injury (sTBI), yet limited data exist to guide their use. We aimed to describe the use of continuous infusions of these medications in children with sTBI, to determine temporal trends during the first week of management, and to evaluate associations with in-hospital mortality.
methodsWe conducted a secondary analysis of the Approaches and Decisions in Acute Pediatric Traumatic Brain Injury Trial (NCT04077411, 2014-2017), a prospective multicenter observational study of patients < 18 years old with sTBI (Glasgow Coma Scale ≤ 8) who underwent intracranial pressure monitoring. Continuous analgesic, sedative, and NMB medication infusions administered in the first 7 days after sTBI were analyzed.
resultsData from 929 patients were analyzed with a median Glasgow Coma Scale of 6 (interquartile range 3-7), 14% hospital mortality. In the 7 days after intracranial pressure monitor placement, 866 (93%) patients received an opioid infusion, with 659 (71%) patients having received fentanyl. A total of 679 (73%) patients received benzodiazepine: 671 (72%) patients received midazolam. A total of 362 (39%) patients received NMB, with the most common being vecuronium, administered to 141 (15%) patients. Propofol was administered to 264 (28%) patients, alpha-2 agonist to 263 (28%) patients, and ketamine to 4 (0.43%) patients. The median number of infusions per patient was 2 (interquartile range 1-2), with the highest number on intensive care unit day 2. Morphine and dexmedetomidine infusions were used more often in survivors than nonsurvivors (33 vs. 16%, and 30 vs. 9%, respectively, p < 0.001).
conclusionsFentanyl and midazolam were the most common analgesic and sedative continuous infusions during acute pediatric sTBI management. Propofol and dexmedetomidine were used less frequently. Opioid (specifically morphine) and dexmedetomidine infusions were associated with survival. Larger studies are needed to determine the safest and most effective analgesia, sedation, and NMB medication strategy for children with sTBI.
Indexed as
Identifiers
What OpenQuestion holds
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.