2,589 results match your criteria Pediatrics Sedation


Mechanical Ventilation during ECMO: Lessons from Clinical Trials and Future Prospects.

Semin Respir Crit Care Med 2022 Jun 27. Epub 2022 Jun 27.

Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.

Acute Respiratory Distress Syndrome (ARDS) accounts for 10% of ICU admissions and affects 3 million patients each year. Despite decades of research, it is still associated with one of the highest mortality rates in the critically ill. Advances in supportive care, innovations in technologies and insights from recent clinical trials have contributed to improved outcomes and a renewed interest in the scope and use of Extracorporeal life support (ECLS) as a treatment for severe ARDS, including high flow veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) and low flow Extracorporeal Carbon Dioxide Removal (ECCO2R). Read More

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ARDS clinical practice guideline 2021.

Respir Investig 2022 Jun 23. Epub 2022 Jun 23.

Department of Anesthesiology, Osaka Women's and Children's Hospital, Osaka, Japan.

Background: The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021.

Methods: The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. Read More

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Predictors of Laryngospasm During 276,832 Episodes of Pediatric Procedural Sedation.

Ann Emerg Med 2022 Jun 22. Epub 2022 Jun 22.

Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.

Study Objective: Laryngospasm is a rare but potentially life-threatening complication of sedation. The objective of this study was to perform a predictor analysis of biologically plausible predictors and the interventions and outcomes associated with laryngospasm.

Methods: Secondary analysis of prospectively collected data from consecutively sedated patients, less than or equal to 22 years of age, at multiple locations at 64 member institutions of the Pediatric Sedation Research Consortium. Read More

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Neuroimaging for Pediatric Non-First-Time Seizures in the Emergency Department.

Neurol Clin Pract 2022 Jun;12(3):e7-e13

Section of Neurology (EM, SR, ES, JJ, JM, RM, MS), Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora; Section of Emergency Medicine Department of Pediatrics (RDM, JL), University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora; and Division of Neurology (CAP), Department of Pediatrics, Children's Hospital of Philadelphia, PA.

Background And Objectives: Neuroimaging is often part of the workup for a pediatric patient presenting with a seizure to an emergency department (ED). We aim to evaluate when neuroimaging in the ED for children with a non-first-time seizure, or nonindex seizure (NIS), is associated with an acute change in management (ACM).

Methods: This is a retrospective cohort study of all pediatric patients presenting to an ED from 2008 to 2018 with a NIS, excluding repeat febrile seizures, who underwent neuroimaging. Read More

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Expert Multinational Consensus Statement for Total Intravenous Anaesthesia (TIVA) Using the Delphi Method.

J Clin Med 2022 Jun 17;11(12). Epub 2022 Jun 17.

Department of Anaesthesia, NHS Grampian, Aberdeen AB25 2ZD, UK.

The use of total intravenous anaesthesia (TIVA) has been well established as an anaesthetic technique over the last few decades. Significant variation in practice exists however, and volatile agents are still commonly used. This study aims to determine the motivations and barriers for using TIVA over the use of volatile agents by analysing the opinion of several international anaesthetists with specific expertise or interests. Read More

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Pediatric Procedural Sedation and Analgesia (PROSA) in the Leuven University Hospitals: An Audit on Efficacy and Safety.

Children (Basel) 2022 May 25;9(6). Epub 2022 May 25.

Department of Pediatrics, University Hospitals UZ Leuven, 3000 Leuven, Belgium.

The hospital can be a stressful environment for a child. To address the increase in demands for pediatric procedural sedation, the PROSA team initiative was started in the Leuven University Hospitals in 2014. In this study, we assessed the efficacy and safety of this project since its initiation. Read More

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Clinical features, electroencephalogram, and biomarkers in pediatric sepsis-associated encephalopathy.

Sci Rep 2022 Jun 23;12(1):10673. Epub 2022 Jun 23.

Department of Pediatrics, D'Or Institute for Research & Education (IDOR), Rio de Janeiro, RJ, 22281-100, Brazil.

To date, no specific diagnostic criteria for sepsis-associated encephalopathy (SAE) have been established. We studied 33 pediatric patients with sepsis prospectively and evaluated the level of consciousness, the presence of delirium, electroencephalographic (EEG) findings, and plasma levels of neuron-specific enolase and S100-calcium-binding protein-B. A presumptive diagnosis of SAE was primarily considered in the presence of a decreased level of consciousness and/or delirium (clinical criteria), but specific EEG abnormalities were also considered (EEG criteria). Read More

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L-NAC reverses of the adverse effects of fentanyl infusion on ventilation and blood-gas chemistry.

Biomed Pharmacother 2022 Jun 17;153:113277. Epub 2022 Jun 17.

Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Pharmacology, Case Western Reserve University, Cleveland, OH 44106, USA. Electronic address:

There is an urgent need for development of drugs that are able to reverse the adverse effects of opioids on breathing and arterial blood-gas (ABG) chemistry while preserving opioid analgesia. The present study describes the effects of bolus injections of N-acetyl-L-cysteine (L-NAC, 500 μmol/kg, IV) on ventilatory parameters, ABG chemistry, Alveolar-arterial (A-a) gradient, sedation (righting reflex) and analgesia status (tail-flick latency assay) in unanesthetized adult male Sprague Dawley rats receiving a continuous infusion of fentanyl (1 μg/kg/min, IV). Fentanyl infusion elicited pronounced disturbances in (1) ventilatory parameters (e. Read More

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Standardized Scoring Tool and Weaning Guideline to Reduce Opioids in Critically Ill Neonates.

Pediatr Qual Saf 2022 May-Jun;7(3):e562. Epub 2022 Jun 14.

Division of Neonatology, Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania.

Introduction: Pain impacts brain development for neonates, causing deleterious neurodevelopmental outcomes. Prescription opioids for analgesia or sedation are common; however, prolonged opioid exposure in neonates is associated with neurodevelopmental impairment. Balancing the impact of inadequate pain control against prolonged opioid exposure in neonates is a clinical paradox. Read More

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Clinical Outcomes of Acute Respiratory Failure Associated With Noninvasive and Invasive Ventilation in a Pediatric ICU.

Respir Care 2022 Jun 14. Epub 2022 Jun 14.

Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan.

Background: It remains unknown if pediatric patients failing initial noninvasive ventilation (NIV) experience worse clinical outcomes than those successfully treated with NIV or those primarily intubated.

Methods: This was a single-center, retrospective review of patients admitted with acute respiratory failure to the University of Michigan pediatric intensive care or cardiothoracic ICUs and receiving NIV or invasive mechanical ventilation as first-line therapy.

Results: One hundred seventy subjects met inclusion criteria and were enrolled: 65 NIV success, 55 NIV failure, and 50 invasive mechanical ventilation alone. Read More

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The Efficacy of Virtual Reality Game Preparation for Children Scheduled for Magnetic Resonance Imaging Procedures (IMAGINE): Protocol for a Randomized Controlled Trial.

JMIR Res Protoc 2022 Jun 13;11(6):e30616. Epub 2022 Jun 13.

Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île de Montréal, Montreal, QC, Canada.

Background: It is known that magnetic resonance imaging (MRI) procedures generate fear and anxiety. Children may become restless during scanning, which results in movement artifacts requiring the MRI procedure to be repeated with sedation. Few studies seem to have looked at the effect of immersive virtual reality (IVR) on anxiety in children scheduled for MRI scans and how to identify which children are more responsive. Read More

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Usefulness of Neurosonogram in Critical Ill Neonates.

Cureus 2022 May 10;14(5):e24882. Epub 2022 May 10.

Pediatrics, Jawaharlal Nehru Medical College, Wardha, IND.

The Cranial Neurosonogram is the preferred method for viewing the infant's brain. Ultrasound tools are portable and may be used at the NICU bedside. This corresponds to the concept of point-of-care testing. Read More

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Analgesia, Sedation, Paralytics, Delirium, and Iatrogenic Withdrawal.

Pediatr Clin North Am 2022 Jun;69(3):531-546

Butler University College of Pharmacy and Health Sciences, Riley Hospital for Children, 705 Riley Hospital Drive, Room W6111, Indianapolis, IN 46202, USA.

The care of the critically ill child often includes medications used for the relief of pain and anxiety. Children have key differences in pharmacokinetics and pharmacodynamics compared with adults that should always be considered to achieve safe medication use in this population. Pain must be addressed, and sedative use should be minimized when possible. Read More

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Sedation for less invasive surfactant administration in preterm infants: a systematic review and meta-analysis.

Pediatr Res 2022 Jun 2. Epub 2022 Jun 2.

Department of Pediatrics, Division of Neonatology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.

Background: Sedation to preterm neonates receiving less invasive surfactant administration (LISA) for respiratory distress syndrome is controversial.

Methods: Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies (OS) to evaluate the effect of sedative drugs for LISA on respiratory outcomes and adverse effects.

Results: One RCT (78 neonates) and two OS (519 neonates) were analyzed in pairwise meta-analysis and 30 studies (2164 neonates) in proportion-based meta-analysis. Read More

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Cardiovascular computed tomography in pediatric congenital heart disease: A state of the art review.

J Cardiovasc Comput Tomogr 2022 May 6. Epub 2022 May 6.

Division of Pediatric Cardiology, Department of Pediatrics, New York Presbyterian/Columbia University Irving Medical Center, New York, NY, USA. Electronic address:

Cardiac computed tomography (CCT) has increasingly been used in the assessment of both children and adults with congenital heart disease (CHD), in part due to advances in CCT technology and an increased prevalence of adults with palliated CHD. It serves as a complimentary modality to echocardiography, cardiac magnetic resonance imaging and cardiac catheterization. CCT can provide unique diagnostic information, is less invasive and less likely to require sedation compared to other modalities. Read More

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Sedation Practices in the PICU: An Unexpected Casualty of COVID-19.

Crit Care Explor 2022 Jun 27;4(6):e0713. Epub 2022 May 27.

Department of Pediatrics, Critical Care Medicine, Weill Cornell Medical College, New York, NY.

Pediatric intensivists often use an "analgosedation" approach in mechanically ventilated children. By prioritizing analgesia and minimizing sedation, patients experience less delirium. However, when COVID-19 surged, our pediatric intensive care unit providers were tasked with caring for adults with severe acute hypoxemic respiratory failure (AHRF). Read More

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Case Report: Anesthetic Management of Cesarean Section in a Patient With Paraplegia.

Front Med (Lausanne) 2022 11;9:783796. Epub 2022 May 11.

Department of Anesthesiology, Chongqing Health Center for Women and Children, Chonqing, China.

Background: With the advancement of medical science and rehabilitative care, more women with spinal cord injury (SCI) can conceive. However, autonomic hyperreflexia due to SCI complicates anesthesia management during cesarean sections.

Case Presentation: This study reports the anesthesia management in a woman with paraplegia with a T6 SCI lesion who underwent a cesarean section. Read More

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The involvement and autonomy of young children undergoing elective paediatric cardiac surgery: a qualitative study.

J Cardiothorac Surg 2022 May 31;17(1):136. Epub 2022 May 31.

Great Ormond Street Hospital for Children NHS Trust, London, UK.

Background: Standards generally reported in the literature about informing children and respecting their consent or refusal before elective heart surgery may differ from actual practice. This research aims to summarize the main themes in the literature about paediatric anaesthesia and compare these with research findings on how health professionals counsel young children before elective heart surgery, respect their consent or refusal, and maintain patient-centred care.

Methods: This qualitative research involved: literature reviews about children's consent to surgery and major interventions; observations of wards, clinics and medical meetings in two paediatric cardiology departments, October 2019 to February 2020; audio-recorded semi-structured interviews with 45 hospital staff, including 5 anaesthetists, and related experts, November 2019 to April 2021; interviews with 16 families, with children aged 6- to 15-years and their parents shortly after elective heart surgery, and some months later (reported in other papers); thematic data analysis; and research reports on how different professions contribute to children's informed decisions for heart surgery. Read More

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Atypical trigeminocardiac reflex during intranasal dexmedetomidine sedation of a 6-month-old premature baby.

BMJ Case Rep 2022 May 31;15(5). Epub 2022 May 31.

Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina.

The trigeminocardiac reflex (TCR) is an established brainstem reflex leading to parasympathetic dysrhythmias-including haemodynamic irregularities, apnoea and gastric hypermotility-during stimulation of any sensory branches of the trigeminal nerve. Most of the clinical knowledge about TCR was gathered from general anaesthesia observations, not from procedural sedation.We present a case of a 6-month-old premature baby experiencing the reflex twice under dexmedetomidine-propofol-sedation while undergoing ophthalmic and ear examination. Read More

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Evaluation of Intranasal Midazolam for Pediatric Sedation during the Suturing of Traumatic Lacerations: A Systematic Review.

Children (Basel) 2022 Apr 29;9(5). Epub 2022 Apr 29.

Facultad de Fisioterapia y Enfermería, Universidad de Castilla La Mancha, 45071 Toledo, Spain.

Objective: The objective of this study was to evaluate the efficacy and safety of intranasal midazolam as part of a paediatric sedation and analgesic procedure during the suturing of traumatic lacerations in paediatric emergency departments.

Methodology: A systematic review of clinical trials was completed in July 2021. The databases consulted were PUBMED, SCOPUS, WEB OF SCIENCE, NICE and Virtual Health Library. Read More

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Psychological impact of the COVID-19 epidemic among healthcare workers in paediatric intensive care units in China.

PLoS One 2022 27;17(5):e0265377. Epub 2022 May 27.

Department of Pediatric Intensive Care Unit, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R China.

To perform a mental health evaluation and an early psychological intervention for healthcare workers (HCWs) during the coronavirus disease 2019 (COVID-19) epidemic, an online survey was conducted among 3055 HCWs in the paediatric intensive care units (PICUs) of 62 hospitals in China on March 26, 2020, by the Neurology and Sedation Professional Group, Emergency Department, Paediatrics Branch, Chinese Medical Association. The questionnaire was divided into three parts, including general information, the Impact of Event Scale-Revised (IES-R), and the Depression Anxiety Stress Scale-21 (DASS-21). The results show that a total of 970 HCWs (45. Read More

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Quality Improvement Initiative to Improve Initiation and Acceptability of Noninvasive Ventilation in Critically Ill Children.

Indian J Pediatr 2022 May 25. Epub 2022 May 25.

Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.

Objectives: To evaluate if the use of a quality improvement (QI) initiative improves initiation and acceptability of noninvasive ventilation (NIV) in critically ill children with respiratory distress.

Methods: The study was carried out in 3 phases over a period of 6 mo in the pediatric intensive care unit of a tertiary care hospital in children aged 2 mo to 14 y of age. In phase 1, data were collected for 1 mo and reasons for NIV failure were identified. Read More

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Interventions for the management of Pain and Sedation in Newborns undergoing Therapeutic hypothermia for hypoxic-ischemic encephalopathy (IPSNUT): protocol of a systematic review.

Syst Rev 2022 05 23;11(1):101. Epub 2022 May 23.

Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

Background: Clinical research has shown that therapeutic hypothermia after neonatal hypoxic-ischemic injury improves survival without disability. There is no consensus regarding pain relief or sedation during therapeutic hypothermia in newborns; however, therapeutic hypothermia seems to be associated with pain and stress, and adequate analgesia and sedation are central to maximize the effect of therapeutic hypothermia. Pain needs to be adequately managed in all patients, especially the newborn infant due to the potential short- and long-term negative effects of inadequately treated pain in this population. Read More

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Opioid analgesia and temperature regulation are associated with EEG background activity and MRI outcomes in neonates with mild-to-moderate hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia.

Eur J Paediatr Neurol 2022 Apr 16;39:11-18. Epub 2022 Apr 16.

Research Centre, Sainte-Justine University Hospital Center, 3175 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada; Institute of Biomedical Engineering, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1A4, Canada; Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1A4, Canada. Electronic address:

Background: Therapeutic hypothermia (TH) without sedation may lead to discomfort, which may be associated with adverse consequences in neonates with hypoxic-ischemic encephalopathy (HIE). The aim of this study was to assess the association between level of exposure to opioids and temperature, with electroencephalography (EEG) background activity post-TH and magnetic resonance imaging (MRI) brain injury in neonates with HIE.

Methods: Thirty-one neonates with mild-to-moderate HIE who underwent TH were identified. Read More

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Paediatric magnetic resonance imaging adaptations without the use of sedation or anaesthesia: A narrative review.

J Med Imaging Radiat Sci 2022 May 15. Epub 2022 May 15.

City University of London, Northampton Square, London, United Kingdom.

Magnetic Resonance Imaging (MRI) produces images with high soft tissue contrast without the use of ionising radiation, making it a valuable tool for scanning paediatrics. However, it can be difficult to scan children when they are awake, resulting often in poor image quality scans and necessitating the use of sedation and general anaesthesia (GA). The aim of sedation and anaesthesia is to reduce anxiety and movement during image acquisition, thereby improving compliance and image quality. Read More

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Correction to: Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey.

Crit Care 2022 May 16;26(1):139. Epub 2022 May 16.

Pediatric Intensive Care Unit, Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.

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Survey of Anesthesia, Sedation, and Non-sedation Practices for Children Undergoing Repetitive Cranial or Craniospinal Radiotherapy.

Cureus 2022 Apr 12;14(4):e24075. Epub 2022 Apr 12.

Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, Houston, USA.

Background Children undergoing cranial or craniospinal radiotherapy may require over 30 treatments within a six-week period. Facilitating these many treatments with the patient under anesthesia presents a significant challenge, and the most preferred anesthetic methods remain unknown. The primary goal of this study was to determine the most preferred anesthetic methods and agents for children undergoing daily cranial or craniospinal radiotherapy. Read More

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Splint Duration and Not the Mode of Anesthesia Is the Main Factor Influencing Avascular Necrosis After Closed Reduction for Developmental Dysplasia of the Hip in Kosovo.

Front Pediatr 2022 26;10:850605. Epub 2022 Apr 26.

Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.

The aim of this study was to determine whether the use of analgesia and sedation (AS) as opposed to general anesthesia (GA) for closed reduction and spica casting of children with severe developmental dysplasia of the hip (DDH) influenced the long-term incidence of avascular necrosis (AVN). In a prospective, randomized, single-blinded clinical trial we investigated 100 pediatric patients with DDH type IIIa, IIIb, and IV (according to Graf classification), who were randomly assigned into the group receiving AS, and the group receiving GA. Baseline demographics, splint duration, and type of DDH were carefully assessed. Read More

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Future roles of artificial intelligence in early pain management of newborns.

Paediatr Neonatal Pain 2021 Sep 5;3(3):134-145. Epub 2021 Aug 5.

Computer Science and Engineering Department University of South Florida Tampa FL USA.

The advent of increasingly sophisticated medical technology, surgical interventions, and supportive healthcare measures is raising survival probabilities for babies born premature and/or with life-threatening health conditions. In the United States, this trend is associated with greater numbers of neonatal surgeries and higher admission rates into neonatal intensive care units (NICU) for newborns at all birth weights. Following surgery, current pain management in NICU relies primarily on narcotics (opioids) such as morphine and fentanyl (about 100 times more potent than morphine) that lead to a number of complications, including prolonged stays in NICU for opioid withdrawal. Read More

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September 2021