Children hospitalized in a pediatric intensive care unit are frequently distressed. The purpose of this study was to identify the patterns of use of sedative agents in pediatric critical care patients. A questionnaire survey was mailed to 45 directors of Pediatric Critical Care Fellowship Training Programs listed in Critical Care Medicine, January 1989. The response rate was 75.6% (34 questionnaires). The most commonly identified goals of sedation were reduced patient discomfort or distress and fewer unplanned extubations. The agents most frequently employed for this purpose were opioids (morphine or fentanyl), chloral hydrate, or benzodiazepines. Although conventional doses are used, opioids and benzodiazepines are often given hourly or by continuous infusion. Satisfaction with the efficacy and safety of commonly only used opioids was greater (most common response "very satisfied") than for the benzodiazepines ("some-what satisfied"). The physician's or nurse's clinical impression was reported to be "most important" criterion for deciding when a patient required a dose of sedative; objective criteria were selected as less important. The majority of patients (65.7%) in the surveyed units were ideally "sedated to the point of no distress with as-needed medication." The majority of respondents (76.4%) identified efficacy as the major problem with sedation. Drug withdrawal was considered to be the major problem with sedative use by only a minority of respondents (6.9%). Although withdrawal is seen in 61.8% of units, it is generally treated when recognized, rather than prevented by routine tapering of sedation. Optimal sedation of pediatric intensive care unit patients is considered problematic, despite the use of frequent doses of many sedatives. Systematic investigation of pharmacodynamic response to these agents in the pediatric critical care population is indicated.
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February 1993
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February 01 1993
Pediatric Intensive Care Sedation: Survey of Fellowship Training Programs
Celeste M. Marx;
Celeste M. Marx
From the Departments of Pediatrics and Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH
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David I. Rosenberg;
David I. Rosenberg
From the Departments of Pediatrics and Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH
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Bruce Ambuel;
Bruce Ambuel
From the Departments of Pediatrics and Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH
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Kim W. Hamlett;
Kim W. Hamlett
From the Departments of Pediatrics and Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH
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Jeffrey L. Blumer
Jeffrey L. Blumer
From the Departments of Pediatrics and Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH
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Pediatrics (1993) 91 (2): 369–378.
Article history
Received:
April 27 1992
Accepted:
August 13 1992
Citation
Celeste M. Marx, David I. Rosenberg, Bruce Ambuel, Kim W. Hamlett, Jeffrey L. Blumer; Pediatric Intensive Care Sedation: Survey of Fellowship Training Programs. Pediatrics February 1993; 91 (2): 369–378. 10.1542/peds.91.2.369
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