Anita K Patel1, Eduardo Trujillo-Rivera2, Farhana Faruqe3, Julia A Heneghan1, T Elizabeth Workman2, Qing Zeng-Treitler2, James Chamberlain4, Hiroki Morizono5, Dongkyu Kim6, James E Bost7, Murray M Pollack1. 1. Division of Critical Care Medicine, Department of Pediatrics, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC. 2. Division of Biomedical Informatics, George Washington University School of Medicine and Health Sciences, Washington, DC. 3. Children's National Health System, Washington, DC. 4. Division of Emergency Medicine, Department of Pediatrics, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC. 5. Department of Genomics and Precision Medicine, GWU School of Medicine and Health Sciences, Washington, DC. 6. Department of Pediatrics, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC. 7. Division of Biostatistics and Study Methadology, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC.
Abstract
OBJECTIVES: To describe the pharmaceutical management of sedation, analgesia, and neuromuscular blockade medications administered to children in ICUs. DESIGN: A retrospective analysis using data extracted from the national database Health Facts. SETTING: One hundred sixty-one ICUs in the United States with pediatric admissions. PATIENTS: Children in ICUs receiving medications from 2009 to 2016. EXPOSURE/INTERVENTION: Frequency and duration of administration of sedation, analgesia, and neuromuscular blockade medications. MEASUREMENTS AND MAIN RESULTS: Of 66,443 patients with a median age of 1.3 years (interquartile range, 0-14.5), 63.3% (n = 42,070) received nonopioid analgesic, opioid analgesic, sedative, and/or neuromuscular blockade medications consisting of 83 different agents. Opioid and nonopioid analgesics were dispensed to 58.4% (n = 38,776), of which nonopioid analgesics were prescribed to 67.4% (n = 26,149). Median duration of opioid analgesic administration was 32 hours (interquartile range, 7-92). Sedatives were dispensed to 39.8% (n = 26,441) for a median duration of 23 hours (interquartile range, 3-84), of which benzodiazepines were most common (73.4%; n = 19,426). Neuromuscular-blocking agents were dispensed to 17.3% (n = 11,517) for a median duration of 2 hours (interquartile range, 1-15). Younger age was associated with longer durations in all medication classes. A greater proportion of operative patients received these medication classes for a longer duration than nonoperative patients. A greater proportion of patients with musculoskeletal and hematologic/oncologic diseases received these medication classes. CONCLUSIONS: Analgesic, sedative, and neuromuscular-blocking medications were prescribed to 63.3% of children in ICUs. The durations of opioid analgesic and sedative medication administration found in this study can be associated with known complications, including tolerance and withdrawal. Several medications dispensed to pediatric patients in this analysis are in conflict with Food and Drug Administration warnings, suggesting that there is potential risk in current sedation and analgesia practice that could be reduced with practice changes to improve efficacy and minimize risks.
OBJECTIVES: To describe the pharmaceutical management of sedation, analgesia, and neuromuscular blockade medications administered to children in ICUs. DESIGN: A retrospective analysis using data extracted from the national database Health Facts. SETTING: One hundred sixty-one ICUs in the United States with pediatric admissions. PATIENTS: Children in ICUs receiving medications from 2009 to 2016. EXPOSURE/INTERVENTION: Frequency and duration of administration of sedation, analgesia, and neuromuscular blockade medications. MEASUREMENTS AND MAIN RESULTS: Of 66,443 patients with a median age of 1.3 years (interquartile range, 0-14.5), 63.3% (n = 42,070) received nonopioid analgesic, opioid analgesic, sedative, and/or neuromuscular blockade medications consisting of 83 different agents. Opioid and nonopioid analgesics were dispensed to 58.4% (n = 38,776), of which nonopioid analgesics were prescribed to 67.4% (n = 26,149). Median duration of opioid analgesic administration was 32 hours (interquartile range, 7-92). Sedatives were dispensed to 39.8% (n = 26,441) for a median duration of 23 hours (interquartile range, 3-84), of which benzodiazepines were most common (73.4%; n = 19,426). Neuromuscular-blocking agents were dispensed to 17.3% (n = 11,517) for a median duration of 2 hours (interquartile range, 1-15). Younger age was associated with longer durations in all medication classes. A greater proportion of operative patients received these medication classes for a longer duration than nonoperative patients. A greater proportion of patients with musculoskeletal and hematologic/oncologic diseases received these medication classes. CONCLUSIONS: Analgesic, sedative, and neuromuscular-blocking medications were prescribed to 63.3% of children in ICUs. The durations of opioid analgesic and sedative medication administration found in this study can be associated with known complications, including tolerance and withdrawal. Several medications dispensed to pediatric patients in this analysis are in conflict with Food and Drug Administration warnings, suggesting that there is potential risk in current sedation and analgesia practice that could be reduced with practice changes to improve efficacy and minimize risks.
Authors: Anita K Patel; Katherine V Biagas; Eunice C Clarke; Linda M Gerber; Elizabeth Mauer; Gabrielle Silver; Paul Chai; Rozelle Corda; Chani Traube Journal: Pediatr Crit Care Med Date: 2017-02 Impact factor: 3.624
Authors: Kanwaljeet J S Anand; Amy E Clark; Douglas F Willson; John Berger; Kathleen L Meert; Jerry J Zimmerman; Rick Harrison; Joseph A Carcillo; Christopher J L Newth; Stephanie Bisping; Richard Holubkov; J Michael Dean; Carol E Nicholson Journal: Pediatr Crit Care Med Date: 2013-01 Impact factor: 3.624
Authors: Eduardo A Trujillo Rivera; James M Chamberlain; Anita K Patel; Hiroki Morizono; Julia A Heneghan; Murray M Pollack Journal: Pediatr Crit Care Med Date: 2022-05-05 Impact factor: 3.971
Authors: Murray M Pollack; James M Chamberlain; Anita K Patel; Julia A Heneghan; Eduardo A Trujillo Rivera; Dongkyu Kim; James E Bost Journal: Pediatr Crit Care Med Date: 2021-02-01 Impact factor: 3.971
Authors: Julia A Heneghan; Eduardo A Trujillo Rivera; Qing Zeng-Treitler; Farhana Faruqe; Hiroki Morizono; James E Bost; Murray M Pollack; Anita K Patel Journal: Pediatr Crit Care Med Date: 2020-09 Impact factor: 3.971
Authors: Anita K Patel; Jiaxiang Gai; Eduardo Trujillo-Rivera; Farhana Faruqe; Dongkyu Kim; James E Bost; Murray M Pollack Journal: JAMA Netw Open Date: 2021-12-01
Authors: Eduardo A Trujillo Rivera; Anita K Patel; James M Chamberlain; T Elizabeth Workman; Julia A Heneghan; Douglas Redd; Hiroki Morizono; Dongkyu Kim; James E Bost; Murray M Pollack Journal: Pediatr Crit Care Med Date: 2021-01-01 Impact factor: 3.971
Authors: Eduardo A Trujillo Rivera; Anita K Patel; Qing Zeng-Treitler; James M Chamberlain; James E Bost; Julia A Heneghan; Hiroki Morizono; Murray M Pollack Journal: Pediatr Crit Care Med Date: 2021-01-01 Impact factor: 3.971