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Observational Study
. 2019 Dec;20(12):1111-1117.
doi: 10.1097/PCC.0000000000002071.

Sedative and Analgesic Drug Rotation Protocol in Critically Ill Children With Prolonged Sedation: Evaluation of Implementation and Efficacy to Reduce Withdrawal Syndrome

Eva Sanavia  1 , Santiago Mencía, Sarah N Lafever, María J Solana, Miriam Garcia, Jesús López-Herce
Affiliations
Observational Study

Sedative and Analgesic Drug Rotation Protocol in Critically Ill Children With Prolonged Sedation: Evaluation of Implementation and Efficacy to Reduce Withdrawal Syndrome

Eva Sanavia et al. Pediatr Crit Care Med. 2019 Dec.

Abstract

Objectives: The first aim of this study was to assess the implementation of a sedative and analgesic drug rotation protocol in a PICU. The second aim was to analyze the incidence of withdrawal syndrome, drug doses, and time of sedative or analgesic drug infusion in children after the implementation of the new protocol.

Design: Prospective observational study.

Setting: PICU of a tertiary care hospital between June 2012 and June 2016.

Patients: All patients between 1 month and 16 years old admitted to the PICU who received continuous IV infusion of sedative or analgesic drugs for more than 4 days were included in the study.

Interventions: A sedative and analgesic drug rotation protocol was designed. The level of sedation, analgesia, and withdrawal syndrome were monitored with validated scales. The relationship between compliance with the protocol and the incidence of withdrawal syndrome was studied.

Measurements and main results: One-hundred pediatric patients were included in the study. The protocol was followed properly in 35% of patients. Sixty-seven percent of the overall cohort presented with withdrawal syndrome. There was a lower incidence rate of withdrawal syndrome (34.3% vs 84.6%; p < 0.001), shorter PICU length of stay (median 16 vs 25 d; p = 0.003), less time of opioid infusion (median 5 vs 7 d for fentanyl; p = 0.004), benzodiazepines (median 5 vs 9 d; p = 0.001), and propofol (median 4 vs 8 d; p = 0.001) in the cohort of children in which the protocol was followed correctly.

Conclusions: Our results show that compliance with the drug rotation protocol in critically ill children requiring prolonged sedation may reduce the appearance of withdrawal syndrome without increasing the risk of adverse effects. Furthermore, it may reduce the time of continuous IV infusions for most sedative and analgesic drugs and the length of stay in PICU.

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Comment in

  • Sedative Drug Rotation: Game-Changer or Simply Changing the Name of the Game?
    Traube C. Traube C. Pediatr Crit Care Med. 2019 Dec;20(12):1185-1186. doi: 10.1097/PCC.0000000000002115. Pediatr Crit Care Med. 2019. PMID: 31804435 No abstract available.
  • Rotating Analgosedation.
    Spentzas T. Spentzas T. Pediatr Crit Care Med. 2019 Dec;20(12):1212. doi: 10.1097/PCC.0000000000002117. Pediatr Crit Care Med. 2019. PMID: 31804450 No abstract available.
  • The authors reply.
    Sanavia E, Mencía S, López-Herce J. Sanavia E, et al. Pediatr Crit Care Med. 2019 Dec;20(12):1212-1213. doi: 10.1097/PCC.0000000000002161. Pediatr Crit Care Med. 2019. PMID: 31804451 No abstract available.
  • Clonidine Doses For Sedation in the PICU.
    de Castro REV, Martins RSO, Prata-Barbosa A, de Magalhães-Barbosa MC. de Castro REV, et al. Pediatr Crit Care Med. 2020 Jan;21(1):110. doi: 10.1097/PCC.0000000000002162. Pediatr Crit Care Med. 2020. PMID: 31899759 No abstract available.
  • The authors reply.
    Sanavia E, Mencía S, López-Herce J. Sanavia E, et al. Pediatr Crit Care Med. 2020 Jan;21(1):110-111. doi: 10.1097/PCC.0000000000002148. Pediatr Crit Care Med. 2020. PMID: 31899760 No abstract available.
  • Sedative and Analgesic Drug Rotation Protocol in Critically Ill Children.
    Awasthi PR, Angurana SK, Bansal A. Awasthi PR, et al. Pediatr Crit Care Med. 2020 Sep;21(9):851. doi: 10.1097/PCC.0000000000002390. Pediatr Crit Care Med. 2020. PMID: 32890092 No abstract available.
  • The authors reply.
    Sanavia E, Mencía S, López-Herce J. Sanavia E, et al. Pediatr Crit Care Med. 2020 Sep;21(9):851-852. doi: 10.1097/PCC.0000000000002399. Pediatr Crit Care Med. 2020. PMID: 32890093 No abstract available.

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