Sedative and analgesic drug rotation protocol in critically ill children with prolonged sedation: evaluation of Implementation and efficacy to reduce withdrawal syndrome
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2019
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Lippincott, Williams & Wilkins
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Sanavia, Eva MD1; Mencía, Santiago MD, PhD1–4; Lafever, Sarah N. MD1–4; Solana, María J. MD, PhD1–4; Garcia, Miriam MD1–4; López-Herce, Jesús MD, PhD1–4. Sedative and Analgesic Drug Rotation Protocol in Critically Ill Children With Prolonged Sedation: Evaluation of Implementation and Efficacy to Reduce Withdrawal Syndrome*. Pediatric Critical Care Medicine 20(12):p 1111-1117, December 2019. | DOI: 10.1097/PCC.0000000000002071
Abstract
Este artículo, publicado en la prestigiosa revista Pediatric Critical Care Medicine, presenta los resultados de un estudio prospectivo que evaluó la implementación y eficacia de un protocolo de rotación de sedantes y analgésicos en niños críticamente enfermos que requieren sedación prolongada.
Los resultados demostraron que la adherencia al protocolo se asoció con una reducción significativa de la incidencia de síndrome de abstinencia, así como una disminución del tiempo de infusión de los fármacos sedantes y analgésicos y una reducción de la estancia hospitalaria.
Description
Objectives:
The first aim of this study was to assess the implementation of a sedative and analgesic drug rotation protocol in a PICU. The second aim was to analyze the incidence of withdrawal syndrome, drug doses, and time of sedative or analgesic drug infusion in children after the implementation of the new protocol.
Design:
Prospective observational study.
Setting:
PICU of a tertiary care hospital between June 2012 and June 2016.
Patients:
All patients between 1 month and 16 years old admitted to the PICU who received continuous IV infusion of sedative or analgesic drugs for more than 4 days were included in the study.
Interventions:
A sedative and analgesic drug rotation protocol was designed. The level of sedation, analgesia, and withdrawal syndrome were monitored with validated scales. The relationship between compliance with the protocol and the incidence of withdrawal syndrome was studied.
Measurements and Main Results:
One-hundred pediatric patients were included in the study. The protocol was followed properly in 35% of patients. Sixty-seven percent of the overall cohort presented with withdrawal syndrome. There was a lower incidence rate of withdrawal syndrome (34.3% vs 84.6%; p < 0.001), shorter PICU length of stay (median 16 vs 25 d; p = 0.003), less time of opioid infusion (median 5 vs 7 d for fentanyl; p = 0.004), benzodiazepines (median 5 vs 9 d; p = 0.001), and propofol (median 4 vs 8 d; p = 0.001) in the cohort of children in which the protocol was followed correctly.
Conclusions:
Our results show that compliance with the drug rotation protocol in critically ill children requiring prolonged sedation may reduce the appearance of withdrawal syndrome without increasing the risk of adverse effects. Furthermore, it may reduce the time of continuous IV infusions for most sedative and analgesic drugs and the length of stay in PICU.