Critical Illness
Conditions
Keywords
interruption, critically ill, sedation, pediatrics, critically ill, ventilated children
Brief summary
Critically ill children are often sedated in order to relieve them from anxiety and discomfort, and to facilitate their care. There is little information on the effects of prolonged and continuous use of sedatives and analgesic agents in critically ill children. In adult intensive care unit (ICU) patients, daily interruption of sedative infusions accelerates recovery resulting in a reduction in the average duration of mechanical ventilation of 2.4 days as well as a reduction in average ICU length of stay of 3.5 days. These results were achieved without an increased rate of adverse events potentially linked to less sedation and associated with a reduction of common complications of critical illness and without negative psychological effects. It is unknown whether these results can be extrapolated to critically ill children. Moreover, the possible risk of complications associated with less sedation, such as accidental self-extubation, is probably higher in children. Also, the need for intermittent bolus administrations in children treated with intermittent sedation could nullify the reduction in the use of sedatives. It is unknown if daily interruption of sedatives is feasible in critically ill children. The researchers studied the effects of daily interruption of sedatives in critically ill children on the total amount of sedatives used and risks of complications.
Interventions
DRUGdaily interruption of sedatives
Sponsors
Radboud University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 12 Years
Healthy volunteers
No
Inclusion criteria
* Intubated and mechanically ventilated for \> 24 hours * Expect further mechanical ventilation for \> 48 hours * Receiving midazolam and morphine for sedation * Written informed consent given by parents
Exclusion criteria
* Inclusion in another trial * Transfer from an outside institution where sedatives had been administered * Neuromuscular blockers * Metabolic disease * Neuromuscular disease * Encephalopathy * Epilepsy * Pulmonary hypertension * Neurotrauma * Raised intracranial pressure * Life expectancy less than a month/infaust prognosis
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| BIS monitoring | Until extubation or 28 days |
| amount of (near) incidents | Until extubation or 28 days |
| total amount of sedatives administered | Until extubation or 28 days |
| time to wake up (after sedation is stopped), comfort scale | Until extubation or 28 days |
Secondary
| Measure | Time frame |
|---|---|
| time on ventilator | Until extubation or 28 days |
| LOS on ICU | Until extubation or 28 days |
Countries
Netherlands
Outcome results
None listed