A survey of current practices in sedation, analgesia, withdrawal, and delirium management in paediatric cardiac ICUs

Valentine, Kevin; Cisco, Michael J.; Lasa, Javier J.; Achuff, Barbara-Jo; Kudchadkar, Sapna R.; Staveski, Sandra

doi:10.1017/s1047951122004115

Cited by 3 publications

(1 citation statement)

References 30 publications

(38 reference statements)

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“…(3) A 2022 survey including over 200 European PICUs as well as a survey in pediatric cardiac ICUs showed large variation in dose and choice of analgesic drugs. (4,5) Currently, most centers prescribe at least one opioid as primary analgesic after cardiac surgery. (2) Cardiopulmonary bypass (CPB) may alter pharmacokinetics (PK) after cardiac surgery ).…”

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confidence: 99%

Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial

Zeilmaker-Roest,

de Vries-Rink,

Rosmalen

et al. 2024

Preprint

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Background To determine whether intermittent intravenous (IV) paracetamol as primary analgesic would significantly reduce morphine consumption in children aged 0–3 years after cardiac surgery with cardiopulmonary bypass.Methods Multi-center, randomized, double-blinded, controlled trial in four level-3 Pediatric Intensive Care Units (PICU) in the Netherlands and Belgium. Inclusion period; March 2016 - July 2020. Children aged 0–3 years, undergoing cardiac surgery with cardiopulmonary bypass were eligible. Patients were randomized to continuous morphine or intermittent IV paracetamol as primary analgesic after a loading dose of 100 mcg/kg morphine was administered at the end of surgery. Rescue morphine was given if Numeric Rating Scale (NRS) scores for pain exceeded predetermined cutoff values. Primary outcome was weight-adjusted cumulative morphine dose in mcg/kg in the first 48 hours post-operative. For the comparison of the primary outcome between groups, the non-parametric Van Elteren test with stratification by center was used.Results In total, 828 were screened and finally 208 patients were included; parents of 315 patients did not give consent and 305 were excluded for various reasons. One hundred and two patients received intermittent IV paracetamol, 106 received continuous morphine. The median cumulative morphine consumption in the first 48 hours postoperative in the IV paracetamol group was 5 times lower (79%) than that in the morphine group (median, 145.0 (IQR, 115.0-432.5) mcg/kg vs 692.6 (IQR, 532.7- 856.1) mcg/kg ; P < 0.00001). The rescue morphine consumption was similar between the groups (p = 0.38). Non-inferiority analysis of IV paracetamol showed no differences between groups in number of NRS scores indicating pain (p = 0.61).Conclusions In children aged 0–3 years undergoing cardiac surgery, use of intermittent IV paracetamol reduces the weight-adjusted cumulative morphine consumption in the first 48 hours after surgery by 79% with equal pain relief showing equipoise for IV paracetamol as primary analgesic.Trial Registration Clinicaltrials.gov, Identifier: NCT05853263; EudraCT Number: 2015-001835-20.

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mentioning

confidence: 99%

Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial

Zeilmaker-Roest,

de Vries-Rink,

Rosmalen

et al. 2024

Preprint

View full text Add to dashboard Cite

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Updates and Clinical Implications of Pediatric Delirium

Flagg

Mauney

2023

Critical Care Nursing Clinics of North America

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Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial

Zeilmaker-Roest,

de Vries-Rink,

van Rosmalen

et al. 2024

Crit Care

View full text Add to dashboard Cite

Background To determine whether intermittent intravenous (IV) paracetamol as primary analgesic would significantly reduce morphine consumption in children aged 0–3 years after cardiac surgery with cardiopulmonary bypass. Methods Multi-center, randomized, double-blinded, controlled trial in four level-3 Pediatric Intensive Care Units (PICU) in the Netherlands and Belgium. Inclusion period; March 2016–July 2020. Children aged 0–3 years, undergoing cardiac surgery with cardiopulmonary bypass were eligible. Patients were randomized to continuous morphine or intermittent IV paracetamol as primary analgesic after a loading dose of 100 mcg/kg morphine was administered at the end of surgery. Rescue morphine was given if numeric rating scale (NRS) pain scores exceeded predetermined cutoff values. Primary outcome was median weight-adjusted cumulative morphine dose in mcg/kg in the first 48 h postoperative. For the comparison of the primary outcome between groups, the nonparametric Van Elteren test with stratification by center was used. For comparison of the proportion of patients with one or more NRS pain scores of 4 and higher between the two groups, a non-inferiority analysis was performed using a non-inferiority margin of 20%. Results In total, 828 were screened and finally 208 patients were included; parents of 315 patients did not give consent and 305 were excluded for various reasons. Fourteen of the enrolled 208 children were withdrawn from the study before start of study medication leaving 194 patients for final analysis. One hundred and two patients received intermittent IV paracetamol, 106 received continuous morphine. The median weight-adjusted cumulative morphine consumption in the first 48 h postoperative in the IV paracetamol group was 5 times lower (79%) than that in the morphine group (median, 145.0 (IQR, 115.0–432.5) mcg/kg vs 692.6 (IQR, 532.7–856.1) mcg/kg; P < 0.001). The rescue morphine consumption was similar between the groups (p = 0.38). Non-inferiority of IV paracetamol administration in terms of NRS pain scores was proven; difference in proportion − 3.1% (95% CI − 16.6–10.3%). Conclusions In children aged 0–3 years undergoing cardiac surgery, use of intermittent IV paracetamol reduces the median weight-adjusted cumulative morphine consumption in the first 48 h after surgery by 79% with equal pain relief showing equipoise for IV paracetamol as primary analgesic. Trial Registration Clinicaltrials.gov, Identifier: NCT05853263; EudraCT Number: 2015-001835-20.

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A survey of current practices in sedation, analgesia, withdrawal, and delirium management in paediatric cardiac ICUs

Cited by 3 publications

References 30 publications

Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial

Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial

Updates and Clinical Implications of Pediatric Delirium

Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial

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