679: ENTERAL PENTOBARBITAL IN DIFFICULT-TO-SEDATE CRITICALLY ILL CHILDREN

Abstract

Introduction: Providing adequate sedation and analgesia to the critically ill and mechanically ventilated children is essential for comfort, to decrease anxiety, to facilitate care, and prevent self-harm. Undersedation is associated with both physical and psychological risks and can lead to long term consequences. The difficult analgosedation is common and challenging condition in the Pediatric Intensive Care Units (PICU). Pentobarbital is a short acting barbiturate commonly used in high doses as continuous infusion in refractory status epilepticus (SE) and refractory intracranial hypertension. Intermittent Enteral pentobarbital (EPB) is well studied and commonly used in procedural sedation but not as an adjunct agent in sedating critically ill patients. Methods: In a retrospective chart-review study, we identified 13 critically ill and mechanically ventilated children who received intermittent EPB when the first line agents were insufficient in providing adequate sedation. Patient’s demographics, disease characteristics, State Behavioral State (SBS) scores and the cumulative doses of sedatives before and after EPB initiation were collected. Results: The patients were between the age of 2 months and 27 months, 77% were male. The patients received EPB with doses ranging from 2-4 mg/kg/dose at frequency ranging from 2-6 times/day. The addition of EPB was associated with lower SBS scores in 62% of the patients and on average lower doses of opioids (decreased by 11%), Benzodiazepines (BZD) (decreased by 5%) and alpha-blockers (decreased by 20%). None of the patients experienced significant adverse effect. Conclusions: The use of enteral pentobarbital in mechanically ventilated critically ill children with difficult analgosedation is effective and safe. This study is the first report on using enteral pentobarbital for sedation in the PICU. Larger randomized controlled or observational trials are needed to further explore its safety across the different pediatric age groups, as well as the optimal dosage and timing.