TY - JOUR
T1 - Analgesia and Sedation at Terminal Extubation
T2 - A Secondary Analysis from Death One Hour after Terminal Extubation Study Data∗
AU - Tripathi, Sandeep
AU - Laksana, Eugene
AU - McCrory, Michael C.
AU - Hsu, Stephanie
AU - Zhou, Alice X.
AU - Burkiewicz, Kimberly
AU - Ledbetter, David R.
AU - Aczon, Melissa D.
AU - Shah, Sareen
AU - Siegel, Linda
AU - Fainberg, Nina
AU - Morrow, Katie R.
AU - Avesar, Michael
AU - Chandnani, Harsha K.
AU - Shah, Jui
AU - Pringle, Charlene
AU - Winter, Meredith C.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Objectives: To describe the doses of opioids and benzodiazepines administered around the time of terminal extubation (TE) to children who died within 1 hour of TE and to identify their association with the time to death (TTD). Design: Secondary analysis of data collected for the Death One Hour After Terminal Extubation study. Setting: Nine U.S. hospitals. Patients: Six hundred eighty patients between 0 and 21 years who died within 1 hour after TE (2010-2021). Measurements and Main Results: Medications included total doses of opioids and benzodiazepines 24 hours before and 1 hour after TE. Correlations between drug doses and TTD in minutes were calculated, and multivariable linear regression performed to determine their association with TTD after adjusting for age, sex, last recorded oxygen saturation/Fio2ratio and Glasgow Coma Scale score, inotrope requirement in the last 24 hours, and use of muscle relaxants within 1 hour of TE. Median age of the study population was 2.1 years (interquartile range [IQR], 0.4-11.0 yr). The median TTD was 15 minutes (IQR, 8-23 min). Forty percent patients (278/680) received either opioids or benzodiazepines within 1 hour after TE, with the largest proportion receiving opioids only (23%, 159/680). Among patients who received medications, the median IV morphine equivalent within 1 hour after TE was 0.75 mg/kg/hr (IQR, 0.3-1.8 mg/kg/hr) (n = 263), and median lorazepam equivalent was 0.22 mg/kg/hr (IQR, 0.11-0.44 mg/kg/hr) (n = 118). The median morphine equivalent and lorazepam equivalent rates after TE were 7.5-fold and 22-fold greater than the median pre-extubation rates, respectively. No significant direct correlation was observed between either opioid or benzodiazepine doses before or after TE and TTD. After adjusting for confounding variables, regression analysis also failed to show any association between drug dose and TTD. Conclusions: Children after TE are often prescribed opioids and benzodiazepines. For patients dying within 1 hour of TE, TTD is not associated with the dose of medication administered as part of comfort care.
AB - Objectives: To describe the doses of opioids and benzodiazepines administered around the time of terminal extubation (TE) to children who died within 1 hour of TE and to identify their association with the time to death (TTD). Design: Secondary analysis of data collected for the Death One Hour After Terminal Extubation study. Setting: Nine U.S. hospitals. Patients: Six hundred eighty patients between 0 and 21 years who died within 1 hour after TE (2010-2021). Measurements and Main Results: Medications included total doses of opioids and benzodiazepines 24 hours before and 1 hour after TE. Correlations between drug doses and TTD in minutes were calculated, and multivariable linear regression performed to determine their association with TTD after adjusting for age, sex, last recorded oxygen saturation/Fio2ratio and Glasgow Coma Scale score, inotrope requirement in the last 24 hours, and use of muscle relaxants within 1 hour of TE. Median age of the study population was 2.1 years (interquartile range [IQR], 0.4-11.0 yr). The median TTD was 15 minutes (IQR, 8-23 min). Forty percent patients (278/680) received either opioids or benzodiazepines within 1 hour after TE, with the largest proportion receiving opioids only (23%, 159/680). Among patients who received medications, the median IV morphine equivalent within 1 hour after TE was 0.75 mg/kg/hr (IQR, 0.3-1.8 mg/kg/hr) (n = 263), and median lorazepam equivalent was 0.22 mg/kg/hr (IQR, 0.11-0.44 mg/kg/hr) (n = 118). The median morphine equivalent and lorazepam equivalent rates after TE were 7.5-fold and 22-fold greater than the median pre-extubation rates, respectively. No significant direct correlation was observed between either opioid or benzodiazepine doses before or after TE and TTD. After adjusting for confounding variables, regression analysis also failed to show any association between drug dose and TTD. Conclusions: Children after TE are often prescribed opioids and benzodiazepines. For patients dying within 1 hour of TE, TTD is not associated with the dose of medication administered as part of comfort care.
KW - life support care
KW - organ donation
KW - palliative care
KW - patient comfort
KW - pediatric intensive care unit
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U2 - 10.1097/PCC.0000000000003209
DO - 10.1097/PCC.0000000000003209
M3 - Article
C2 - 36877028
AN - SCOPUS:85160968108
SN - 1529-7535
VL - 24
SP - 463
EP - 472
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 6
ER -