Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure

for the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVES:: To describe sedation management in children supported on extracorporeal membrane oxygenation for acute respiratory failure. DESIGN:: Secondary analysis of prospectively collected data from a multicenter randomized trial of sedation (Randomized Evaluation of Sedation Titration for Respiratory Failure). SETTING:: Twenty-one U.S. PICUs. PATIENTS:: One thousand two hundred fifty-five children, 2 weeks to 17 years old, with moderate/severe pediatric acute respiratory distress syndrome. INTERVENTIONS:: Sedation managed per usual care or Randomized Evaluation of Sedation Titration for Respiratory Failure protocol. MEASUREMENTS AND MAIN RESULTS:: Sixty-one Randomized Evaluation of Sedation Titration for Respiratory Failure patients (5%) with moderate/severe pediatric acute respiratory distress syndrome were supported on extracorporeal membrane oxygenation, including 29 managed per Randomized Evaluation of Sedation Titration for Respiratory Failure protocol. Most extracorporeal membrane oxygenation patients received neuromuscular blockade (46%) or were heavily sedated with State Behavioral Scale scores –3/–2 (34%) by extracorporeal membrane oxygenation day 3. Median opioid and benzodiazepine doses on the day of cannulation, 0.15 mg/kg/hr (3.7 mg/kg/d) and 0.11 mg/kg/hr (2.8 mg/kg/d), increased by 36% and 58%, respectively, by extracorporeal membrane oxygenation day 3. In the 41 patients successfully decannulated prior to study discharge, patients were receiving 0.40 mg/kg/hr opioids (9.7 mg/kg/d) and 0.39 mg/kg/hr benzodiazepines (9.4 mg/kg/d) at decannulation, an increase from cannulation of 108% and 192%, respectively (both p < 0.001). Extracorporeal membrane oxygenation patients experienced more clinically significant iatrogenic withdrawal than moderate/severe pediatric acute respiratory distress syndrome patients managed without extracorporeal membrane oxygenation support (p < 0.001). Compared to extracorporeal membrane oxygenation patients managed per Randomized Evaluation of Sedation Titration for Respiratory Failure protocol, usual care extracorporeal membrane oxygenation patients received more opioids during the study period (mean cumulative dose of 183.0 vs 89.8 mg/kg; p = 0.02), over 6.5 greater exposure days (p = 0.002) with no differences in wakefulness or agitation. CONCLUSIONS:: In children, the initiation of extracorporeal membrane oxygenation support is associated with deep sedation, substantial sedative exposure, and increased frequency of iatrogenic withdrawal syndrome. A standardized, goal-directed, nurse-driven sedation protocol may help mitigate these effects.

Original languageEnglish (US)
JournalCritical Care Medicine
DOIs
StateAccepted/In press - Jun 13 2017

Fingerprint

Extracorporeal Membrane Oxygenation
Respiratory Insufficiency
Adult Respiratory Distress Syndrome
Opioid Analgesics
Pediatrics
Benzodiazepines
Catheterization
Deep Sedation
Neuromuscular Blockade
Wakefulness
Patient Discharge
Hypnotics and Sedatives
Multicenter Studies
Nurses

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

for the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators (Accepted/In press). Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure. Critical Care Medicine. https://doi.org/10.1097/CCM.0000000000002540

Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure. / for the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators.

In: Critical Care Medicine, 13.06.2017.

Research output: Contribution to journalArticle

for the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators 2017, 'Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure', Critical Care Medicine. https://doi.org/10.1097/CCM.0000000000002540
for the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators. Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure. Critical Care Medicine. 2017 Jun 13. https://doi.org/10.1097/CCM.0000000000002540
for the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators. / Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure. In: Critical Care Medicine. 2017.
@article{9df47ee600654aa9b82c314258c37edb,
title = "Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure",
abstract = "OBJECTIVES:: To describe sedation management in children supported on extracorporeal membrane oxygenation for acute respiratory failure. DESIGN:: Secondary analysis of prospectively collected data from a multicenter randomized trial of sedation (Randomized Evaluation of Sedation Titration for Respiratory Failure). SETTING:: Twenty-one U.S. PICUs. PATIENTS:: One thousand two hundred fifty-five children, 2 weeks to 17 years old, with moderate/severe pediatric acute respiratory distress syndrome. INTERVENTIONS:: Sedation managed per usual care or Randomized Evaluation of Sedation Titration for Respiratory Failure protocol. MEASUREMENTS AND MAIN RESULTS:: Sixty-one Randomized Evaluation of Sedation Titration for Respiratory Failure patients (5{\%}) with moderate/severe pediatric acute respiratory distress syndrome were supported on extracorporeal membrane oxygenation, including 29 managed per Randomized Evaluation of Sedation Titration for Respiratory Failure protocol. Most extracorporeal membrane oxygenation patients received neuromuscular blockade (46{\%}) or were heavily sedated with State Behavioral Scale scores –3/–2 (34{\%}) by extracorporeal membrane oxygenation day 3. Median opioid and benzodiazepine doses on the day of cannulation, 0.15 mg/kg/hr (3.7 mg/kg/d) and 0.11 mg/kg/hr (2.8 mg/kg/d), increased by 36{\%} and 58{\%}, respectively, by extracorporeal membrane oxygenation day 3. In the 41 patients successfully decannulated prior to study discharge, patients were receiving 0.40 mg/kg/hr opioids (9.7 mg/kg/d) and 0.39 mg/kg/hr benzodiazepines (9.4 mg/kg/d) at decannulation, an increase from cannulation of 108{\%} and 192{\%}, respectively (both p < 0.001). Extracorporeal membrane oxygenation patients experienced more clinically significant iatrogenic withdrawal than moderate/severe pediatric acute respiratory distress syndrome patients managed without extracorporeal membrane oxygenation support (p < 0.001). Compared to extracorporeal membrane oxygenation patients managed per Randomized Evaluation of Sedation Titration for Respiratory Failure protocol, usual care extracorporeal membrane oxygenation patients received more opioids during the study period (mean cumulative dose of 183.0 vs 89.8 mg/kg; p = 0.02), over 6.5 greater exposure days (p = 0.002) with no differences in wakefulness or agitation. CONCLUSIONS:: In children, the initiation of extracorporeal membrane oxygenation support is associated with deep sedation, substantial sedative exposure, and increased frequency of iatrogenic withdrawal syndrome. A standardized, goal-directed, nurse-driven sedation protocol may help mitigate these effects.",
author = "{for the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators} and Schneider, {James B.} and Todd Sweberg and Asaro, {Lisa A.} and Aileen Kirby and David Wypij and Thiagarajan, {Ravi R.} and Curley, {Martha A.Q.}",
year = "2017",
month = "6",
day = "13",
doi = "10.1097/CCM.0000000000002540",
language = "English (US)",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure

AU - for the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators

AU - Schneider, James B.

AU - Sweberg, Todd

AU - Asaro, Lisa A.

AU - Kirby, Aileen

AU - Wypij, David

AU - Thiagarajan, Ravi R.

AU - Curley, Martha A.Q.

PY - 2017/6/13

Y1 - 2017/6/13

N2 - OBJECTIVES:: To describe sedation management in children supported on extracorporeal membrane oxygenation for acute respiratory failure. DESIGN:: Secondary analysis of prospectively collected data from a multicenter randomized trial of sedation (Randomized Evaluation of Sedation Titration for Respiratory Failure). SETTING:: Twenty-one U.S. PICUs. PATIENTS:: One thousand two hundred fifty-five children, 2 weeks to 17 years old, with moderate/severe pediatric acute respiratory distress syndrome. INTERVENTIONS:: Sedation managed per usual care or Randomized Evaluation of Sedation Titration for Respiratory Failure protocol. MEASUREMENTS AND MAIN RESULTS:: Sixty-one Randomized Evaluation of Sedation Titration for Respiratory Failure patients (5%) with moderate/severe pediatric acute respiratory distress syndrome were supported on extracorporeal membrane oxygenation, including 29 managed per Randomized Evaluation of Sedation Titration for Respiratory Failure protocol. Most extracorporeal membrane oxygenation patients received neuromuscular blockade (46%) or were heavily sedated with State Behavioral Scale scores –3/–2 (34%) by extracorporeal membrane oxygenation day 3. Median opioid and benzodiazepine doses on the day of cannulation, 0.15 mg/kg/hr (3.7 mg/kg/d) and 0.11 mg/kg/hr (2.8 mg/kg/d), increased by 36% and 58%, respectively, by extracorporeal membrane oxygenation day 3. In the 41 patients successfully decannulated prior to study discharge, patients were receiving 0.40 mg/kg/hr opioids (9.7 mg/kg/d) and 0.39 mg/kg/hr benzodiazepines (9.4 mg/kg/d) at decannulation, an increase from cannulation of 108% and 192%, respectively (both p < 0.001). Extracorporeal membrane oxygenation patients experienced more clinically significant iatrogenic withdrawal than moderate/severe pediatric acute respiratory distress syndrome patients managed without extracorporeal membrane oxygenation support (p < 0.001). Compared to extracorporeal membrane oxygenation patients managed per Randomized Evaluation of Sedation Titration for Respiratory Failure protocol, usual care extracorporeal membrane oxygenation patients received more opioids during the study period (mean cumulative dose of 183.0 vs 89.8 mg/kg; p = 0.02), over 6.5 greater exposure days (p = 0.002) with no differences in wakefulness or agitation. CONCLUSIONS:: In children, the initiation of extracorporeal membrane oxygenation support is associated with deep sedation, substantial sedative exposure, and increased frequency of iatrogenic withdrawal syndrome. A standardized, goal-directed, nurse-driven sedation protocol may help mitigate these effects.

AB - OBJECTIVES:: To describe sedation management in children supported on extracorporeal membrane oxygenation for acute respiratory failure. DESIGN:: Secondary analysis of prospectively collected data from a multicenter randomized trial of sedation (Randomized Evaluation of Sedation Titration for Respiratory Failure). SETTING:: Twenty-one U.S. PICUs. PATIENTS:: One thousand two hundred fifty-five children, 2 weeks to 17 years old, with moderate/severe pediatric acute respiratory distress syndrome. INTERVENTIONS:: Sedation managed per usual care or Randomized Evaluation of Sedation Titration for Respiratory Failure protocol. MEASUREMENTS AND MAIN RESULTS:: Sixty-one Randomized Evaluation of Sedation Titration for Respiratory Failure patients (5%) with moderate/severe pediatric acute respiratory distress syndrome were supported on extracorporeal membrane oxygenation, including 29 managed per Randomized Evaluation of Sedation Titration for Respiratory Failure protocol. Most extracorporeal membrane oxygenation patients received neuromuscular blockade (46%) or were heavily sedated with State Behavioral Scale scores –3/–2 (34%) by extracorporeal membrane oxygenation day 3. Median opioid and benzodiazepine doses on the day of cannulation, 0.15 mg/kg/hr (3.7 mg/kg/d) and 0.11 mg/kg/hr (2.8 mg/kg/d), increased by 36% and 58%, respectively, by extracorporeal membrane oxygenation day 3. In the 41 patients successfully decannulated prior to study discharge, patients were receiving 0.40 mg/kg/hr opioids (9.7 mg/kg/d) and 0.39 mg/kg/hr benzodiazepines (9.4 mg/kg/d) at decannulation, an increase from cannulation of 108% and 192%, respectively (both p < 0.001). Extracorporeal membrane oxygenation patients experienced more clinically significant iatrogenic withdrawal than moderate/severe pediatric acute respiratory distress syndrome patients managed without extracorporeal membrane oxygenation support (p < 0.001). Compared to extracorporeal membrane oxygenation patients managed per Randomized Evaluation of Sedation Titration for Respiratory Failure protocol, usual care extracorporeal membrane oxygenation patients received more opioids during the study period (mean cumulative dose of 183.0 vs 89.8 mg/kg; p = 0.02), over 6.5 greater exposure days (p = 0.002) with no differences in wakefulness or agitation. CONCLUSIONS:: In children, the initiation of extracorporeal membrane oxygenation support is associated with deep sedation, substantial sedative exposure, and increased frequency of iatrogenic withdrawal syndrome. A standardized, goal-directed, nurse-driven sedation protocol may help mitigate these effects.

UR - http://www.scopus.com/inward/record.url?scp=85020720505&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020720505&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000002540

DO - 10.1097/CCM.0000000000002540

M3 - Article

C2 - 28614197

AN - SCOPUS:85020720505

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

ER -