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Abstract O-22: SEDATION MANAGEMENT FOR CRITICALLY ILL CHILDREN WITH PRE-EXISTING COGNITIVE IMPAIRMENTS IS IT DIFFERENT?

Best, K.1; Curley, M.A.Q.2; Asaro, L.A.3

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 11
doi: 10.1097/01.pcc.0000537364.26399.22
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1Children’s Hospital of Philadelphia, Department of Nursing- Respiratory Care and Neurodiagnostic Services, Philadelphia, USA

2University of Pennsylvania School of Nursing, Department of Family & Community Health, Philadelphia, USA

3Boston Children’s Hospital, Department of Cardiology, Boston, USA

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Aims & Objectives:

While analgesia and sedation are essential for critically-ill children with pre-existing cognitive impairment (CI), the effectiveness of current strategies in this population remains unexplored. Here we compare current analgesia and sedation management practices between patients with CI and neurotypical (NT) children in the PICU.

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Methods

Secondary analysis of existing data from the RESTORE trial of children admitted to the PICU for acute respiratory failure. We defined CI as baseline Pediatric Cerebral Performance Category (PCPC) score ≥3. Analyses adjusted for age and PRISM III-12 score.

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Results

Of 2449 RESTORE subjects, 412 (17%) had CI. Compared to NT subjects, CI subjects were older (p<0.001) with more severe PARDS (40% vs. 33%; p=0.009), received lower cumulative doses of opioids (median, mg/kg, 14.2 vs. 16.2; p<0.001) and benzodiazepines (10.6 vs. 14.4; p<0.001), and fewer classes of sedative medications (% receiving ≥3 classes, 57% vs. 60%; p<0.001). Three non-verbal intubated subjects with CI received no analgesic or sedative medications. Subjects with CI spent more study days awake and calm (median [IQR], 80% [60–100] vs. 80% [56–100]; p=0.003) and experienced fewer days with an episode of pain (33% [13–56] vs. 38% [14–60]; p=0.005).

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Conclusions

Subjects with CI in this study received lower doses of opioids and benzodiazepines while hospitalized in the PICU, including some who received no analgesia or sedation. These data suggest that while comfort for subjects with CI may have been achieved with less medication, the rationale for this observation is unclear. Further prospective study that includes alternative assessment strategies is warranted.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies