AIM: To study the feasibility of daily interruption of sedatives in critically ill children. METHODS: Prospective randomized controlled open-label trial, performed in a pediatric intensive care unit of a tertiary care teaching and referring hospital. 30 children (0-12 years) receiving mechanically ventilation for >24 h were included. In the intervention group, all sedatives were stopped daily and restarted when COMFORT-behavior score ≥17. The control group received standard care. Primary end points were amounts of sedatives and number of bolus medications in the first 3 days after enrollment and number of (near) incidents. Secondary end points were duration of mechanical ventilation, length of stay in pediatric intensive care, and changes in COMFORT-behavior score. RESULTS:Midazolam and morphine use were lower in the intervention group compared with the control group (P = 0.007 and P = 0.02, respectively), whereas the number of bolus medications did not differ between groups. Two complications were recorded: one patient (intervention group) lost his intravenous line, and one patient (control group) had an unplanned extubation. Duration of mechanical ventilation was significantly shorter in the intervention group compared with the control group (median [interquartile range] of 4 [3-8] and 9 [4-10] days, respectively, P = 0.03). Length of stay in the PICU in the intervention group was significantly shorter than in the control group (median [interquartile range] of 6 [4-9] and 10 [7-15] days, respectively, P = 0.01). CONCLUSIONS:Daily interruption of sedatives in critically ill children is feasible, results in decreased use of sedation, earlier extubation, and shorter length of stay.
RCT Entities:
AIM: To study the feasibility of daily interruption of sedatives in critically ill children. METHODS: Prospective randomized controlled open-label trial, performed in a pediatric intensive care unit of a tertiary care teaching and referring hospital. 30 children (0-12 years) receiving mechanically ventilation for >24 h were included. In the intervention group, all sedatives were stopped daily and restarted when COMFORT-behavior score ≥17. The control group received standard care. Primary end points were amounts of sedatives and number of bolus medications in the first 3 days after enrollment and number of (near) incidents. Secondary end points were duration of mechanical ventilation, length of stay in pediatric intensive care, and changes in COMFORT-behavior score. RESULTS:Midazolam and morphine use were lower in the intervention group compared with the control group (P = 0.007 and P = 0.02, respectively), whereas the number of bolus medications did not differ between groups. Two complications were recorded: one patient (intervention group) lost his intravenous line, and one patient (control group) had an unplanned extubation. Duration of mechanical ventilation was significantly shorter in the intervention group compared with the control group (median [interquartile range] of 4 [3-8] and 9 [4-10] days, respectively, P = 0.03). Length of stay in the PICU in the intervention group was significantly shorter than in the control group (median [interquartile range] of 6 [4-9] and 10 [7-15] days, respectively, P = 0.01). CONCLUSIONS: Daily interruption of sedatives in critically ill children is feasible, results in decreased use of sedation, earlier extubation, and shorter length of stay.
Authors: Parth J Upadhyay; Nienke J Vet; Sebastiaan C Goulooze; Elke H J Krekels; Saskia N de Wildt; Catherijne A J Knibbe Journal: Pharm Res Date: 2021-10-18 Impact factor: 4.200
Authors: Nienke J Vet; Saskia N de Wildt; Carin W M Verlaat; Catherijne A J Knibbe; Miriam G Mooij; Job B M van Woensel; Joost van Rosmalen; Dick Tibboel; Matthijs de Hoog Journal: Intensive Care Med Date: 2015-11-24 Impact factor: 17.440
Authors: Ralf Baron; Andreas Binder; Rolf Biniek; Stephan Braune; Hartmut Buerkle; Peter Dall; Sueha Demirakca; Rahel Eckardt; Verena Eggers; Ingolf Eichler; Ingo Fietze; Stephan Freys; Andreas Fründ; Lars Garten; Bernhard Gohrbandt; Irene Harth; Wolfgang Hartl; Hans-Jürgen Heppner; Johannes Horter; Ralf Huth; Uwe Janssens; Christine Jungk; Kristin Maria Kaeuper; Paul Kessler; Stefan Kleinschmidt; Matthias Kochanek; Matthias Kumpf; Andreas Meiser; Anika Mueller; Maritta Orth; Christian Putensen; Bernd Roth; Michael Schaefer; Rainhild Schaefers; Peter Schellongowski; Monika Schindler; Reinhard Schmitt; Jens Scholz; Stefan Schroeder; Gerhard Schwarzmann; Claudia Spies; Robert Stingele; Peter Tonner; Uwe Trieschmann; Michael Tryba; Frank Wappler; Christian Waydhas; Bjoern Weiss; Guido Weisshaar Journal: Ger Med Sci Date: 2015-11-12