Interruption of Sedation for Early Extubation
Carolyn Murphy Boscia
Brian M. Cummings
Randomized Controlled Trial of Daily Interruption of Sedatives in Critically Ill Children
Verlaat CW, Heesen GP, Vet NJ, et al. Paediatr Anaesth. 2014;24(2):151–156
Background
Continuous sedation during intubation in the pediatric intensive care unit (PICU) allows for adequate pain control and anxiolysis, but carries risks of tolerance, withdrawal, and prolonged recovery. Daily sedation breaks shorten intubation duration and ICU length of stay in adults; this study assessed efficacy of sedation interruption in the PICU setting.
Objectives
To assess whether daily sedation breaks in PICU patients are feasible and to measure their impact on sedative dosing.
Methods
Open-label randomized controlled trial in a 13-bed PICU in the Netherlands from 2004 to 2006.
Patients
30 patients ages 0 to 12 years, intubated >24 hours, and requiring continued mechanical ventilation for >48 hours. Select exclusion criteria: limited ability to assess sedation (e.g., neurologic compromise, neuromuscular blockade), second indication for sedation (e.g., pulmonary hypertension), upper airway pathology, life expectancy <1 month.
Intervention
Daily interruption of sedatives (morphine and midazolam) compared with routine staff-directed sedation administration. Assessments were performed with COMFORT-B observational scale of distress level. Agitation was treated by bolusing sedatives and increasing (or restarting) the continuous infusion.
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