Bibliographic record
Abstract
Introduction: Patients admitted to the pediatric intensive care unit often require long term sedation and analgesia. The agents most often used include fentanyl and midazolam. These agents although effective may not be ideal for long term sedation given hypotension is a common side effect. Ketamine is a analgesic, anesthetic, and amnestic drug that has sympathomimetic properties. There is limited pediatric data for the use of ketamine in long term sedation for critically ill pediatric patients. Hypothesis: The purpose of this study was to assess the use of ketamine for continuous sedation in critically ill pediatric patients. Methods: A retrospective chart review was conducted to collect data on 60 patients who received continuous sedation with ketamine admitted to the PICU at the University Hospital. Information such as DOB, sex, primary diagnosis, drug infusions/medication required was collected. Outcome measures included; adverse events after initiation of ketamine and need for additional sedatives. Results: The most common primary diagnosis was respiratory failure in 35 (65%) of patients. Adverse events were noted in 29 (48.3%) patients including; agitation in 24 (40%), hypertension in 14 (23.3%), tachycardia in 6 (10%), increased secretions in 9 (15%), and emesis in 1 (1.7%). There was a borderline significant reduction among those who received ketamine with midazolam compared to those who did not (40.9% vs. 68.8%, p=0.06, Chi square test). This reduction is due to a decrease in the proportion of subjects experiencing agitation (31.8% vs. 62.5%, p=0.03). The number of agents used with ketamine for continuous sedation ranged from 0 to 4. Patients most commonly received 2 (46.7%) additional agents with ketamine. Additional intermittent doses of sedation were required in 44 (73.3%) patients and ketamine was the most commonly used drug in 26 patients (43.3%). Conclusions: Ketamine can be used for continuous sedation in critically ill pediatric patients with expected side effects of agitation, hypertension, tachycardia, increased secretions, and emesis. The retrospective data shows agitation is less likely when ketamine is used in conjunction with midazolam for continuous sedation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.700 | 0.619 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".