Analgesia and Sedation at Terminal Extubation: A Secondary Analysis From Death One Hour After Terminal Extubation Study Data*-Reference-Cited by-同舟云学术

Analgesia and Sedation at Terminal Extubation: A Secondary Analysis From Death One Hour After Terminal Extubation Study Data*

Published:2023-03-06 Issue:6 Volume:24 Page:463-472
ISSN:1529-7535
Container-title:Pediatric Critical Care Medicine
language:en
Short-container-title:

Author:

Tripathi Sandeep¹,Laksana Eugene²,McCrory Michael C.³,Hsu Stephanie⁴,Zhou Alice X.²,Burkiewicz Kimberly¹,Ledbetter David R.²,Aczon Melissa D.²,Shah Sareen⁵,Siegel Linda⁵,Fainberg Nina⁶,Morrow Katie R.⁷,Avesar Michael⁸,Chandnani Harsha K.⁸,Shah Jui⁸,Pringle Charlene⁹,Winter Meredith C.¹⁰¹¹

Affiliation:

1. Pediatric Intensive Care, OSF HealthCare, Children’s Hospital of Illinois/University of Illinois College of Medicine, Peoria, IL.

2. Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA.

3. Departments of Anesthesiology and Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC.

4. Division of Critical Care Medicine, Children’s Health Medical Center Dallas, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.

5. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Division of Critical Care, Department of Pediatrics, Cohen Children’s Medical Center, Long Island, NY.

6. Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA.

7. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.

8. Division of Pediatric Critical Care Medicine, Loma Linda University Children’s Hospital, Loma Linda, CA.

9. Department of Pediatrics, Critical Care Medicine, University of Florida, Gainesville, FL.

10. Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA.

11. Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA.

Abstract

Objectives: To describe the doses of opioids and benzodiazepines administered around the time of terminal extubation (TE) to children who died within 1 hour of TE and to identify their association with the time to death (TTD). Design: Secondary analysis of data collected for the Death One Hour After Terminal Extubation study. Setting: Nine U.S. hospitals. Patients: Six hundred eighty patients between 0 and 21 years who died within 1 hour after TE (2010–2021). Measurements and Main Results: Medications included total doses of opioids and benzodiazepines 24 hours before and 1 hour after TE. Correlations between drug doses and TTD in minutes were calculated, and multivariable linear regression performed to determine their association with TTD after adjusting for age, sex, last recorded oxygen saturation/Fio 2 ratio and Glasgow Coma Scale score, inotrope requirement in the last 24 hours, and use of muscle relaxants within 1 hour of TE. Median age of the study population was 2.1 years (interquartile range [IQR], 0.4–11.0 yr). The median TTD was 15 minutes (IQR, 8–23 min). Forty percent patients (278/680) received either opioids or benzodiazepines within 1 hour after TE, with the largest proportion receiving opioids only (23%, 159/680). Among patients who received medications, the median IV morphine equivalent within 1 hour after TE was 0.75 mg/kg/hr (IQR, 0.3–1.8 mg/kg/hr) (n = 263), and median lorazepam equivalent was 0.22 mg/kg/hr (IQR, 0.11–0.44 mg/kg/hr) (n = 118). The median morphine equivalent and lorazepam equivalent rates after TE were 7.5-fold and 22-fold greater than the median pre-extubation rates, respectively. No significant direct correlation was observed between either opioid or benzodiazepine doses before or after TE and TTD. After adjusting for confounding variables, regression analysis also failed to show any association between drug dose and TTD. Conclusions: Children after TE are often prescribed opioids and benzodiazepines. For patients dying within 1 hour of TE, TTD is not associated with the dose of medication administered as part of comfort care.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine,Pediatrics, Perinatology and Child Health

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