Patterns of Sedation Weaning in Critically Ill Children Recovering From Acute Respiratory Failure

Kaitlin M. Best, Lisa A. Asaro, Linda S. Franck, David Wypij, Martha A.Q. Curley, Geoffrey L. Allen, Judy A. Ascenzi, Scot T. Bateman, Santiago Borasino, Ira M. Cheifetz, Allison S. Cowl, E. Vincent S. Faustino, Lori D. Fineman, Heidi R. Flori, Mary Jo C. Grant, James H. Hertzog, Larissa Hutchins, Aileen L. Kirby, Jo Anne E. Natale, Phineas P. OrenNagendra Polavarapu, Thomas P. Shanley, Shari Simone, Lauren R. Sorce, Michele A.Vander Heyden

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Objective: To characterize sedation weaning patterns in typical practice settings among children recovering from critical illness. Design: A descriptive secondary analysis of data that were prospectively collected during the prerandomization phase (January to July 2009) of a clinical trial of sedation management. Setting: Twenty-two PICUs across the United States. Patients: The sample included 145 patients, aged 2 weeks to 17 years, mechanically ventilated for acute respiratory failure who received at least five consecutive days of opioid exposure. Interventions: None. Measurements and Main Results: Group comparisons were made between patients with an intermittent weaning pattern, defined as a 20% or greater increase in daily opioid dose after the start of weaning, and the remaining patients defined as having a steady weaning pattern. Demographic and clinical characteristics, tolerance to sedatives, and iatrogenic withdrawal symptoms were evaluated. Sixty-six patients (46%) were intermittently weaned; 79 patients were steadily weaned. Prior to weaning, intermittently weaned patients received higher peak and cumulative doses and longer exposures to opioids and benzodiazepines, demonstrated more sedative tolerance (58% vs 41%), and received more chloral hydrate and barbiturates compared with steadily weaned patients. During weaning, intermittently weaned patients assessed for withdrawal had a higher incidence of Withdrawal Assessment Tool-version 1 scores of greater than or equal to 3 (85% vs 46%) and received more sedative classes compared with steadily weaned patients. Conclusions: This study characterizes sedative administration practices for pediatric patients prior to and during weaning from sedation after critical illness. It provides a novel methodology for describing weaning in an at-risk pediatric population that may be helpful in future research on weaning strategies to prevent iatrogenic withdrawal syndrome.

Original languageEnglish (US)
Pages (from-to)19-29
Number of pages11
JournalPediatric Critical Care Medicine
Issue number1
StatePublished - Jan 1 2016


  • Randomized Evaluation of Sedation Titration for Respiratory Failure
  • Withdrawal Assessment Tool-version 1
  • benzodiazepine
  • opioid
  • sedation
  • weaning
  • withdrawal assessment

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine


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