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Mehl SC, Cunningham ME, Chance MD, et al. Variations in analgesic, sedation, and delirium management between trauma and non-trauma critically ill children. Pediatr Surg Int. 2021;38(2):295-305doi: 10.1007/s00383-021-05039-1.
Mehl, S. C., Cunningham, M. E., Chance, M. D., Zhu, H., Fallon, S. C., Naik-Mathuria, B., Ettinger, N. A., & Vogel, A. M. (2022). Variations in analgesic, sedation, and delirium management between trauma and non-trauma critically ill children. Pediatric surgery international, 38(2), 295-305. https://doi.org/10.1007/s00383-021-05039-1
Mehl, Steven C, et al. "Variations in analgesic, sedation, and delirium management between trauma and non-trauma critically ill children." Pediatric surgery international vol. 38,2 (2022): 295-305. doi: https://doi.org/10.1007/s00383-021-05039-1
Mehl SC, Cunningham ME, Chance MD, Zhu H, Fallon SC, Naik-Mathuria B, Ettinger NA, Vogel AM. Variations in analgesic, sedation, and delirium management between trauma and non-trauma critically ill children. Pediatr Surg Int. 2022 Feb;38(2):295-305. doi: 10.1007/s00383-021-05039-1. Epub 2021 Dec 01. PMID: 34853886.
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Pediatr Surg Int. 2022 Feb;38(2):295-305. doi: 10.1007/s00383-021-05039-1. Epub 2021 Dec 01.

Variations in analgesic, sedation, and delirium management between trauma and non-trauma critically ill children.

Pediatric surgery international

Steven C Mehl, Megan E Cunningham, Michael D Chance, Huirong Zhu, Sara C Fallon, Bindi Naik-Mathuria, Nicholas A Ettinger, Adam M Vogel

Affiliations

  1. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
  2. Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
  3. Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Suite 1210, Houston, TX, 77005, USA.
  4. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA. [email protected].
  5. Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Suite 1210, Houston, TX, 77005, USA. [email protected].

PMID: 34853886 DOI: 10.1007/s00383-021-05039-1

Abstract

INTRODUCTION: Studies have shown the benefit of intensive care unit (ICU) bundled protocols; however, they are primarily derived from medical patients. We hypothesized that patients and their medication profiles are different between critically ill medical, surgical, and trauma patients.

METHODS: The Pediatric Health Information System 2017 dataset was used to perform a retrospective cohort study of critically ill children. The pediatric medical, surgical, and trauma cohorts were separated based on ICD-10 codes. Data collected included demographics, secondary diagnoses, outcomes, and medication data. Medications were grouped as opiates, GABA-agonists, alpha-2 agonists, anti-psychotics, paralytics, and "other" sedatives. A non-parametric Kolmogorov-Smirnov test (KS test) and odds ratios (reference group: medical cohort) were calculated to compare medication administration between the study cohorts for the first 30 ICU days.

RESULTS: A total of 4488 critically ill children (medical 2078, surgical 1650, and trauma 760) were identified. The trauma cohort had increased incidence of delirium (medical 10.8%, surgical 11.5%, trauma 13.8%; p < 0.01) and mortality (medical 5.4%, surgical 2.4%, trauma 11.7%; p < 0.01). For all study cohorts, > 50% received GABA-agonists on ICU days 0-30. With the KS test, there was a significant difference in administration of opiates, GABA-agonists, alpha-2 agonists, anti-psychotics, and "other" sedatives over the first 30 days in the ICU. Relative to medical patients, trauma patients had significantly higher odds of receiving anti-psychotics on ICU days 10-20 and 22-24.

CONCLUSION: Critically ill pediatric trauma, medical, and surgical patients are distinctly different patient populations with differing pharmacologic profiles for analgesia, sedation, and delirium.

LEVEL OF EVIDENCE: Level III (Retrospective Comparative Study).

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Keywords: Analgesia; Children; Critically ill; Delirium; Sedation; Trauma

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