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.
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.
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).
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.