PMID- 28425334
OWN - NLM
STAT- MEDLINE
DCOM- 20191218
LR  - 20220408
IS  - 1525-1489 (Electronic)
IS  - 0885-0666 (Linking)
VI  - 34
IP  - 7
DP  - 2019 Jul
TI  - Remifentanil for Sedation of Children With Traumatic Brain Injury.
PG  - 557-562
LID - 10.1177/0885066617704390 [doi]
AB  - OBJECTIVE: To determine whether remifentanil would provide adequate sedation 
      while allowing frequent and reproducible neurologic assessments in children 
      admitted to the pediatric intensive care unit (PICU) with traumatic brain injury 
      (TBI) during mechanical ventilation. DESIGN: Retrospective review. SETTING: 
      Tertiary care PICU. PATIENTS: Thirty-eight patients over a 30-month period. 
      MEASUREMENTS AND MAIN RESULTS: Median age was 9 years (interquartile range [IQR] 
      2.25-12 years). The median Glasgow Coma Scale (GCS) was 9 (IQR: 8-10). All 
      patients were tracheally intubated and receiving mechanical ventilation. A 
      continuous infusion of remifentanil was started at 0.1 mug/kg/min, and bolus doses 
      of 0.25 to 1 mug/kg were administered every 3 to 5 minutes as needed to reach the 
      desired sedation level. Infusions were stopped at least hourly to perform 
      neurologic examinations. The median remifentanil dose was 0.25 mug/kg/min with an 
      IQR of 0.1 and 0.6 mug/kg/min. The maximum dose for any patient in the cohort was 
      2 mug/kg/min. Median duration of therapy with remifentanil was 20 hours (IQR: 8-44 
      hours). Adequate sedation was achieved with sedation scores (State Behavioral 
      Scale) meeting target levels with a median value of 100% of the time (IQR: 
      79%-100%). Neurologic examinations were able to be performed within a median of 9 
      minutes (IQR: 5-14 minutes) of pausing the infusion. No serious safety events 
      occurred. In 68% of the patients, neurologic examinations remained reassuring 
      during remifentanil infusion, and patients were extubated. The remaining patients 
      were transitioned to traditional sedative agents for long-term management of 
      their traumatic injuries once the neurologic status was deemed stable. 
      CONCLUSION: This data suggest that remifentanil is a suitable sedative agent for 
      use in children with TBI. It provides a rapid onset of sedation with recovery 
      that permits reliable and reproducible clinical examination.
FAU - Hungerford, James L
AU  - Hungerford JL
AD  - 1 Emory Sleep Center, Emory University, Atlanta, GA, USA.
AD  - 2 Children's Healthcare of Atlanta, Children's at Egleston, Critical Care 
      Medicine, Atlanta, GA, USA.
FAU - O'Brien, Nicole
AU  - O'Brien N
AD  - 3 Division of Pediatric Critical Care, Nationwide Children's Hospital, Ohio State 
      University, Columbus, OH, USA.
FAU - Moore-Clingenpeel, Melissa
AU  - Moore-Clingenpeel M
AUID- ORCID: 0000-0003-3782-0726
AD  - 4 Biostatistics Core, Research Institute at Nationwide Children's Hospital, 
      Columbus, OH, USA.
FAU - Sribnick, Eric A
AU  - Sribnick EA
AD  - 5 Department of Neurosurgery, Nationwide Children's Hospital, Ohio State 
      University, Columbus, OH, USA.
FAU - Sargel, Cheryl
AU  - Sargel C
AD  - 6 Department of Pharmacy Services, Nationwide Children's Hospital, Columbus, OH, 
      USA.
FAU - Hall, Mark
AU  - Hall M
AD  - 3 Division of Pediatric Critical Care, Nationwide Children's Hospital, Ohio State 
      University, Columbus, OH, USA.
FAU - Leonard, Jeffrey R
AU  - Leonard JR
AD  - 5 Department of Neurosurgery, Nationwide Children's Hospital, Ohio State 
      University, Columbus, OH, USA.
FAU - Tobias, Joseph D
AU  - Tobias JD
AD  - 3 Division of Pediatric Critical Care, Nationwide Children's Hospital, Ohio State 
      University, Columbus, OH, USA.
AD  - 7 Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, 
      Ohio State University, Columbus, OH, USA.
LA  - eng
PT  - Journal Article
DEP - 20170420
PL  - United States
TA  - J Intensive Care Med
JT  - Journal of intensive care medicine
JID - 8610344
RN  - 0 (Hypnotics and Sedatives)
RN  - P10582JYYK (Remifentanil)
SB  - IM
MH  - Brain Injuries, Traumatic/physiopathology/*therapy
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Glasgow Coma Scale
MH  - Humans
MH  - Hypnotics and Sedatives/*administration & dosage
MH  - *Intensive Care Units, Pediatric
MH  - Male
MH  - Neurologic Examination
MH  - Remifentanil/*administration & dosage
MH  - Respiration, Artificial
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - efficacy
OT  - mechanically ventilated children
OT  - pediatrics
OT  - remifentanil
OT  - sedation
OT  - traumatic brain injury
EDAT- 2017/04/21 06:00
MHDA- 2019/12/19 06:00
CRDT- 2017/04/21 06:00
PHST- 2017/04/21 06:00 [pubmed]
PHST- 2019/12/19 06:00 [medline]
PHST- 2017/04/21 06:00 [entrez]
AID - 10.1177/0885066617704390 [doi]
PST - ppublish
SO  - J Intensive Care Med. 2019 Jul;34(7):557-562. doi: 10.1177/0885066617704390. Epub 
      2017 Apr 20.