Evidence of safety of chloral hydrate for prolonged sedation in PICU in a tertiary teaching hospital in southern Brazil

Martinbiancho, Jacqueline Kohut; Carvalho, Paulo Roberto Antonacci; Trotta, Eliana de Andrade; Schweiger, A.; Rau, Renata Batista; Moreira, Leila Beltrami

doi:10.1007/s00228-009-0694-8

Cited by 12 publications

(5 citation statements)

References 24 publications

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“… Garcia Guerra et al (2016) surveyed Canadian pediatric critical care physicians and found that CH was one of the most commonly used adjunct sedation agents. Martinbiancho et al (2009) examined the use of CH for prolonged sedation in PICU patients in Brazil. They examined all CH-exposed patients in their PICU (mechanically-ventilated and non-ventilated patients) and their primary outcome was adverse drug events, with the most common adverse event being oxygen desaturation.…”

Section: Discussionmentioning

confidence: 99%

“…While these effects may be to an extent dose-related, they have reduced its popularity as a sedation agent. There are very limited data describing the use of CH in an intensive care unit setting with mechanically-ventilated, critically ill children ( Parkinson et al, 1997 ; Jenkins et al, 2007 ; Martinbiancho et al, 2009 ; Cruise et al, 2012 ; Staveski et al, 2014 ; Garcia Guerra et al, 2016 ; Joffe et al, 2017 ). During this report’s study period, we prescribed CH in our pediatric intensive care unit (PICU), typically at 25 mg/kg/dose as often as every 6 h as needed, as an adjunct enteral sedation agent for patients already receiving intravenous agents as part of our routine ICU sedation protocol.…”

Section: Introductionmentioning

confidence: 99%

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Retrospective observational study of chloral hydrate use in mechanically-ventilated pediatric intensive care unit (PICU) patients 2012–2017

et al. 2023

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Introduction: Chloral hydrate (CH) has long been utilized as a pediatric procedural sedation agent. However, very little is published describing CH use in a pediatric intensive care unit (PICU) setting. The aim of this retrospective observational cohort study was to investigate and describe the use of CH in mechanically-ventilated, critically ill children at a large pediatric tertiary referral hospital.Methods: Data were extracted from the hospital electronic medical record and a locally maintained registry of all children admitted to the PICU between 2012 and 2017. Patients admitted to the cardiovascular ICU were not included in this review. The clinical and pharmacy data for 3806 consecutive PICU admissions of mechanically-ventilated, critically ill children were examined.Results: 283 admissions received CH during their first ICU stay. CH-exposed children were younger (16 months vs. 35 months, p < 0.001), the median total dose of CH (indexed to duration of ventilation) was 11 mg/kg/day, the median time to first CH dose was 3 days and more CH doses were administered at night (1112 vs. 958, p < 0.001). We constructed a propensity score to adjust for the differences in patients with and without CH exposure using logistic regression including variables of age, sex, diagnosis, and PRISM3 score. After adjustment, the median length of mechanical ventilation was 5 days longer in the CH-exposed group (95% Confidence Interval [CI] 4–6) compared to unexposed CH patients. Similarly, the median length of ICU duration was 9.4 days longer (95% CI 7.1–11.6) and median length of hospital admission duration was 13.2 days longer (95% CI 7.8–18.6) in CH-exposed patients compared to CH-non-exposed. After adjustment, CH-exposed patients had a 9% higher median exposure to HFOV (95% CI 3.9–14.6), but did not have higher median exposures to new tracheostomy (95% CI −0.4–2.2) or ECMO (95% CI −0.2–5.0).Discussion: As part of an extended sedation regimen in mechanically-ventilated and critically ill children, CH is associated with somewhat higher complexity of illness and longer ICU durations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Retrospective observational study of chloral hydrate use in mechanically-ventilated pediatric intensive care unit (PICU) patients 2012–2017

et al. 2023

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“…It has been shown that midazolam (0.5 mg/kg) compared to oral chloral hydrate (75 mg/kg) had a lower sedation success rate, a longer time to achieve sedation, a longer length of stay in the hospital, and a shorter sedation duration 30 . Also, it has been reported that the averages time from oral administration of chloral hydrate to the onset of sedation was 15 to 60 min 31,32 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Chloral Hydrate Nasal Spray With an Oral Solution for Sedation Before Electroencephalography in Children

Karimi

Aidy

et al. 2022

Preprint

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Background The choice of route of drug administration is given depends not only on the compliance but also on the drug’s pharmacokinetics pathway. In this study, the efficacy, and safety of nasal and oral administration of chloral hydrate in the pediatric ready for electroencephalography were evaluated. Methods 143 infants who had to undergo EEG for the diagnosis of neurological disorders received chloral hydrate between January 2017 and December 2018. Chloral hydrate was administered nasally or orally to infants using doses of 50-100 mg/kg. Clinical parameters are being analyzed to measure the efficacy/safety of nasal spray Vs. oral administration was (a) Heart rate Pre-sedation, (b) Heart rate Post Sedation, (c ) Hypoxemia, (d) Apnea), and (e) Oxygen Supplementation. Mean procedure time, mean recovery time, and total nursing times were calculated. Results Oral chloral hydrate group showed a lower heart rate and also a significantly higher percentage of hypoxemia. Apnea was not statistically different between the groups. The mean procedure time for the nasal and oral solution was ranged from 10 to 15 and 15-25 min, respectively. The mean recovery time for the nasal and oral solution was 5-8 and 10-15 min, respectively. Conclusion Chloral hydrate nasal spray is likely to be more safe and effective than oral in pediatric sedation.

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“…The time from oral administration of chloral hydrate to onset of sedation averages 15 to 60 min. [12,13] Chloral hydrate is a relatively mild sedative that, when administered orally in doses of 50 to 75 mg/kg, induces sleep without untoward respiratory or hemodynamic complications in most infants. [14] …”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of chloral hydrate for conscious sedation of infants in the pediatric cardiovascular intensive care unit

Chen

Chen²,

Xu³

et al. 2017

Medicine

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Evidence of safety of chloral hydrate for prolonged sedation in PICU in a tertiary teaching hospital in southern Brazil

Abstract: The study described the clinical practice of sedation with CH in the PICU setting of a tertiary teaching hospital in southern Brazil. Data suggest that CH is an alternative for prolonged sedation in PICU

Cited by 12 publications

References 24 publications

Retrospective observational study of chloral hydrate use in mechanically-ventilated pediatric intensive care unit (PICU) patients 2012–2017

Retrospective observational study of chloral hydrate use in mechanically-ventilated pediatric intensive care unit (PICU) patients 2012–2017

Comparison of Chloral Hydrate Nasal Spray With an Oral Solution for Sedation Before Electroencephalography in Children

Safety and efficacy of chloral hydrate for conscious sedation of infants in the pediatric cardiovascular intensive care unit

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