Sedative Medications for Critically Ill Children during and after Mechanical Ventilation: A Retrospective Observational Study
Bibliographic record
Abstract
ABSTRACTBackground: Providing safe and effective sedation to critically ill children is challenging. The assessment, prevention, and treatment of symptoms of iatrogenic withdrawal are critical aspects of sedation practice.Objective: To describe the use of sedative medications in critically ill children at McMaster Children’s Hospital.Methods: This retrospective observational study included children admitted over a 12-month period who survived their illness and who received sedation and at least 48 h of invasive ventilation. We collected data from the time of admission to the pediatric intensive care unit to 3 days after discontinuation of sedation.Results:We included 67 children. The median age was 1.6 (interquartile range [IQR] 0.2–6.2) years, and respiratory illnesses were the most common reason for admission (41 [61%]). The children received invasive ventilation for a median of 7 (IQR 4–11) days and sedation for a median of 12 (IQR 6–20) days. Sixty-six children (99%) received an opioid, and all received a benzodiazepine, with median cumulative doses of 14 (IQR 5–27) mg/kg morphine equivalents and 15 (IQR 6–32) mg/kg midazolam equivalents. Dexmedetomidine was given to 31 children (46%), for a median of 8 (IQR 4–12) days. Most children (67%) received sedation after extubation (median duration 7 [IQR 4–14] days). In addition, 32 children (48%) continued to receive sedative medications after transfer to the ward, for a median of 6 (IQR 4–13) days. Forty-two children (63%) had at least one Withdrawal Assessment Tool-1 (WAT-1) score indicative of iatrogenic withdrawal. Children who experienced withdrawal were exposed to more opioids and more benzodiazepines, both per day and overall, and for longer periods.Conclusions: The children in this study were exposed to multiple sedatives, and many continued to receive these medications for an extended period after discontinuation of mechanical ventilation. Iatrogenic withdrawal was common and represents an important opportunity to improve children’s recovery after critical illness. RÉSUMÉContexte : Il est difficile d’offrir une sédation sûre et efficace aux enfants gravement malades. L’évaluation, la prévention et le traitement des symptômes du sevrage iatrogène sont des aspects critiques de la pratiquede la sédation.Objectif : Décrire l’usage de sédatifs pour les enfants gravement maladies à l’Hôpital pour enfants McMaster.Méthodes : Cette étude observationnelle rétrospective comprenait des enfants admis sur une période de 12 mois, ayant survécu à leur maladie et ayant reçu une sédation ainsi qu’une ventilation effractive d’au moins 48 h. Nous avons recueilli des données à partir du moment de leur admission à l’unité de soins pédiatriques intensifs et jusqu’à trois jours après l’arrêt de la sédation.Résultats : Nous avons inclus 67 enfants. L’âge moyen était 1,6 an (écart interquartile [IQR] 0,2–6,2), et les maladies respiratoires étaient la raison la plus fréquente (41 [61 %]). Les enfants ont reçu une ventilation effractive pendant 7 jours en moyenne (IQR 4–11) et une sédation pendant 12 jours en moyenne (IQR 6–20). Soixante-six (99 %) enfants ont reçu un opiacé et ils ont tous reçu une benzodiazépine, avec des doses moyennes cumulées équivalentes à 14 mg/kg (IQR 5–27) de morphine et des doses moyennes cumulées équivalentes à 15 (IQR 6–32) mg/kg de midazolam. Trente et un (46 %) enfants ont reçu de la dexmédétomidine pendant huit jours en moyenne (IQR 4–12). La plupart (67 %) des enfants ont reçu une sédation après l’extubation (durée moyenne 7 [IQR 4–14] jours). De plus, 32 (48 %) enfants ont continué de recevoir des sédatifs après leur transfert dans leur chambre, et cela pendant six jours en moyenne (IQR 4–13). Les scores de quarante-deux (63 %) des enfants obtenus grâce à l’Outil d’évaluation du sevrage, version 1 [WAT-1], révèlent un sevrage iatrogène. Les enfants ayant ressenti des symptoms de sevrage ont été exposés à davantage d’opiacés et de benzodiazépines, aussi bien chaque jour que de manière globale, mais également pendant des périodes prolongées.Conclusions : Les enfants de cette étude ont été exposés à plusieurs sédatifs et bon nombre d’entre eux ont continué à recevoir ces medicaments pendant une période prolongée après l’arrêt de la ventilation mécanique. Le sevrage iatrogène se pratiquait couramment; il s’agit d’une belle occasion d’améliorer la convalescence des enfants après une maladie grave.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".