Trends in Neuropharmacological Medications Over Time in Mechanically Ventilated Nonsurgical Patients Aged Younger Than 3 Years
Notice bibliographique
Résumé
OBJECTIVE: Children who require mechanical ventilation (MV) often receive neuropharmacological agents for analgosedation, although the US Food & Drug Administration has warned that some agents may be neurotoxic in young children. We have previously reported concurrent increases in neuropharmacological agent prescription and usage of rehabilitative services in children with bronchiolitis who received MV. We now aim to assess for similar trends in a more heterogeneous population. METHODS: With institutional review board approval, we queried the Pediatric Health Information Systems (PHIS) database for children aged younger than 36 months with receipt of MV for at least 2 days between 2006 and 2020 and (nonneonatal) intensive care unit admission. Surgical patients were identified by operating room charges and were excluded. Data extracted included demographics, neuropharmacological agents prescribed for at least 2 days, billing for services that evaluate and treat neurological morbidity (eg, physical therapy, swallow evaluation), and clinical outcomes. Temporal trends were analyzed using simple linear regression, Kruskal-Wallis rank-sum testing was used to compare years, and P < .01 defined statistical significance. RESULTS: Among 52 633 patients, the median (IQR) age was 0.4 (0.1-1.2) years, and 56.9% were male. The proportion of children prescribed at least 5 different drugs/drug classes increased significantly from 29.8% in 2006 to 42.4% in 2020. Drugs with significantly increased prescription from 2006 to 2020, respectively, included antipsychotics (1.2% to 6.1%), clonidine (2.4% to 22.1%), dexmedetomidine (4.2% to 57.1%), ketamine (7.9% to 17.0%), methadone (18.5% to 20.7%), and propofol (4.1% to 9.7%). Drugs with significantly decreased prescription included chloral hydrate (18.8% to 3.3%), midazolam (71.6% to 51.1%), and pentobarbital (5.8% to 1.7%). Usage of at least 2 morbidity-related services significantly increased (24.5% in 2006 to 60.6% in 2020). Mortality decreased significantly (12.5% in 2006 to 10.2% in 2020). CONCLUSIONS: Among young, nonsurgical pediatric intensive care unit patients who received MV, there have been concurrent increases in prescription of several neuropharmacological agents and services related to neurologic morbidity. Prospective studies are needed to evaluate the causes and effects of these changes in practice.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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