A survey for pain and sedation medications in pediatric patients during                 extracorporeal membrane oxygenation

Deberry, B; Lynch, James E.; Chernin, Jill M; Zwischenberger, Joseph B.; Chung, Dai H.

doi:10.1191/0267659105pf801oa

Cited by 24 publications

(13 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1-Hydroxymidazolam to midazolam ratio (mean ± SD = 0.21 ± 0.20, [34]) is in agreement with the ratio obtained in pediatric patients who received midazolam after cardiac surgery (mean ± SEM = 0.25 ± 0.03 [59]). In contrast, the ratio obtained by Wildt et al [34] was higher than that in newborn infants <2 weeks of age during continuous infusion of midazolam (0.06 ± 0.05 [28]).…”

Section: Resultssupporting

confidence: 84%

See 1 more Smart Citation

Clinical Pharmacology of Midazolam in Neonates and Children: Effect of Disease—A Review

Pacifici

2014

International Journal of Pediatrics

View full text Add to dashboard Cite

Midazolam is a benzodiazepine with rapid onset of action and short duration of effect. In healthy neonates the half-life (t 1/2) and the clearance (Cl) are 3.3-fold longer and 3.7-fold smaller, respectively, than in adults. The volume of distribution (Vd) is 1.1 L/kg both in neonates and adults. Midazolam is hydroxylated by CYP3A4 and CYP3A5; the activities of these enzymes surge in the liver in the first weeks of life and thus the metabolic rate of midazolam is lower in neonates than in adults. Midazolam acts as a sedative, as an antiepileptic, for those infants who are refractory to standard antiepileptic therapy, and as an anaesthetic. Information of midazolam as an anaesthetic in infants are very little. Midazolam is usually administered intravenously; when minimal sedation is required, intranasal administration of midazolam is employed. Disease affects the pharmacokinetics of midazolam in neonates; multiple organ failure reduces the Cl of midazolam and mechanical ventilation prolongs the t 1/2 of this drug. ECMO therapy increases t 1/2, Cl, and Vd of midazolam several times. The adverse effects of midazolam in neonates are scarce: pain, tenderness, and thrombophlebitis may occur. Respiratory depression and hypotension appear in a limited percentage of infants following intravenous infusion of midazolam. In conclusion, midazolam is a safe and effective drug which is employed as a sedative, as antiepileptic agent, for infants who are refractory to standard antiepileptic therapy, and as an anaesthetic.

show abstract

Section: Resultssupporting

confidence: 84%

“…DeBerry et al [59] determined the general practice guideline used for pain and anxiolytic pharmacotherapy of pediatric patients at ECMO centers. Fentanyl was the most commonly used drug for pain medication and continuous infusion.…”

Section: Resultsmentioning

confidence: 99%

Clinical Pharmacology of Midazolam in Neonates and Children: Effect of Disease—A Review

Pacifici

2014

International Journal of Pediatrics

View full text Add to dashboard Cite

show abstract

“…Although ECMO circuit-related pharmacokinetic alterations in opioid and benzodiazepine concentrations are well-known, little knowledge exists on the clinical effects of these issues outside the neonatal population, and an optimal approach to patient sedation on ECMO has not been achieved(15). The purpose of this paper is to describe sedation management in pediatric patients supported on ECMO for severe respiratory failure and to contrast sedation management using a nurse-implemented goal-directed sedation strategy to usual care.…”

Section: Introductionmentioning

confidence: 99%

Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure*

Schneider

Sweberg

Asaro

et al. 2017

Critical Care Medicine

View full text Add to dashboard Cite

Objective To describe sedation management in children supported on extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. Design Secondary analysis of prospectively collected data from a multicenter randomized trial of sedation (RESTORE). Setting 21 U.S. Pediatric Intensive Care Units. Patients 1255 children, 2 weeks to 17 years old, with moderate/severe PARDS. Interventions Sedation managed per usual care or RESTORE protocol. Measurements and Main Results Sixty-one (5%) RESTORE patients with moderate/severe PARDS were supported on ECMO, including 29 managed per RESTORE protocol. Most ECMO patients received neuromuscular blockade (46%) or were heavily sedated with SBS scores −3/−2 (34%) by ECMO day 3. Median opioid and benzodiazepine doses on the day of cannulation, 0.15 mg/kg/hr (3.7 mg/kg/day) and 0.11 mg/kg/hr (2.8 mg/kg/day), increased by 36% and 58%, respectively, by ECMO day 3. In the 41 patients successfully decannulated prior to study discharge, patients were receiving 0.40 mg/kg/hr opioids (9.7 mg/kg/day) and 0.39 mg/kg/hr benzodiazepines (9.4 mg/kg/day) at decannulation, an increase from cannulation of 108% and 192%, respectively (both p<0.001). ECMO patients experienced more clinically significant iatrogenic withdrawal than moderate/severe PARDS patients managed without ECMO support (p<0.001). Compared to ECMO patients managed per RESTORE protocol, usual care ECMO patients received more opioids during the study period (mean cumulative dose of 183.0 vs 89.8 mg/kg; p=0.02), over 6.5 greater exposure days (p=0.002) with no differences in wakefulness or agitation. Conclusions In children, the initiation of ECMO support is associated with deep sedation, substantial sedative exposure, and increased incidence of iatrogenic withdrawal syndrome. A standardized, goal-directed, nurse-driven sedation protocol may help mitigate these effects.

show abstract

“…For patients on ECMO, optimal sedation is even less defined [45] but is clearly prolonged. Overall, morphine PK seems to be less affected than fentanyl in patients that are on ECMO, which is one reason why it is preferred at many centers.…”

Section: Sedatives and Analgesicsmentioning

confidence: 99%

Pharmacotherapy during pediatric extracorporeal membrane oxygenation: a review

Himebauch

Kilbaugh

Zuppa

2016

Expert Opinion on Drug Metabolism & Toxicology

View full text Add to dashboard Cite

Clinicians caring for pediatric patients treated with ECMO must have an understanding of PK alterations that could lead to either therapeutic failures or increased drug toxicity during this life-saving therapy. Limited data currently exist for optimal drug dosing in pediatric populations who are treated with ECMO. While there are clear challenges to conducting and analyzing data associated with clinical pharmacokinetic-pharmacodynamic studies of children on ECMO, we present techniques to address these challenges. Improved understanding of the physiology and drug disposition during ECMO combined with PK-PD modeling will allow for more adaptable and individualized dosing schemes.

show abstract

A survey for pain and sedation medications in pediatric patients during extracorporeal membrane oxygenation

Cited by 24 publications

References 6 publications

Clinical Pharmacology of Midazolam in Neonates and Children: Effect of Disease—A Review

Clinical Pharmacology of Midazolam in Neonates and Children: Effect of Disease—A Review

Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure*

Pharmacotherapy during pediatric extracorporeal membrane oxygenation: a review

Contact Info

Product

Resources

About