Sevoflurane sedation for weaning from mechanical ventilation in pediatric intensive care unit

Objective Sedation is necessary for patients to achieve comfort and safety, but prolonged sedation can lead to the need for increased doses, resulting in withdrawal syndrome and delayed extubation. Inhaled anaesthetics (IAs) may cause less withdrawal syndrome while providing similar sedative effects to intravenous agents. This study aims to describe the efficacy of halogenated IAs during prolonged sedation and identify any adverse effects on the PICU. Design This is a retrospective, bicentric cohort study. Setting The study was conducted at two PICUs in university hospitals in Paris between January 2018 and December 2020. Patients The study included 50 children (aged 2.2 years, [0.8–7.2]) who received prolonged sedation (> 72 h) and were sedated with volatile anaesthetics for at least 24 h. Interventions No interventions were performed. Measurements and main results The study found a statistically significant reduction in benzodiazepine dosages (μg/kg/h) (118 [62.5; 200] vs 80.0 [32.5; 120], p < 0.01). Similar results were observed for other hypnotics (ketamine 2.00 [1.00; 2.00] vs 1.50 [1.00; 2.00], p = 0.036, mg/kg/h; clonidine: 0.55 [0.35; 1.27] vs 0.20 [0.12; 0.43], p = 0.036, μg/kg/h). For opioids (μg/kg/h), no significant reduction in doses was observed 24 h after IA introduction (4 [1.00; 8.00] vs 4.00 [1.00; 6.70], p = 0.7). No major adverse effects were reported, although 26% of patients developed withdrawal syndrome. Conclusions Halogenated IAs appear to be a promising therapy to reduce the dosages of hypnotics and opioids used during prolonged sedations.

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Recommendations for analgesia and sedation in critically ill children admitted to intensive care unit

Amigoni

Conti

Conio

et al. 2022

J Anesth Analg Crit Care

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We aim to develop evidence-based recommendations for intensivists caring for children admitted to intensive care units and requiring analgesia and sedation. A panel of national paediatric intensivists expert in the field of analgesia and sedation and other specialists (a paediatrician, a neuropsychiatrist, a psychologist, a neurologist, a pharmacologist, an anaesthesiologist, two critical care nurses, a methodologist) started in 2018, a 2-year process. Three meetings and one electronic-based discussion were dedicated to the development of the recommendations (presentation of the project, selection of research questions, overview of text related to the research questions, discussion of recommendations). A telematic anonymous consultation was adopted to reach the final agreement on recommendations. A formal conflict-of-interest declaration was obtained from all the authors. Eight areas of direct interest and one additional topic were considered to identify the best available evidence and to develop the recommendations using the Evidence-to-Decision framework according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. For each recommendation, the level of evidence, the strength of the recommendation, the benefits, the harms and the risks, the benefit/harm balance, the intentional vagueness, the values judgement, the exclusions, the difference of the opinions, the knowledge gaps, and the research opportunities were reported. The panel produced 17 recommendations. Nine were evaluated as strong, 3 as moderate, and 5 as weak. Conclusion: a panel of national experts achieved consensus regarding recommendations for the best care in terms of analgesia and sedation in critically ill children.

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Sevoflurane sedation for weaning from mechanical ventilation in pediatric intensive care unit

Cited by 7 publications

References 28 publications

Sleep Medicine Drugs: Classification and Clinical Results

Sleep Medicine Drugs: Classification and Clinical Results

Halogenated volatile anaesthetics for prolonged sedation in pediatric intensive care unit: first experience in two French pediatric intensive care units

Recommendations for analgesia and sedation in critically ill children admitted to intensive care unit

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