879

Abstract

Introduction: Continuous infusion sedation is associated with adverse outcomes such as prolonged mechanical ventilation, extubation failure, increased risk for development of ventilator-associated pneumonia, and increased intensive care unit and hospital lengths of stay in critically ill adults. The purpose of this study was to examine excess sedation and incidence of extubation failure in pediatric patients. Methods: Data were retrospectively collected on consecutive patients who received mechanical ventilation longer than 48 hours with a continuous infusion benzodiazepine and/or opioid infusion longer than 24 hours between January 1, 2009 through October 31, 2012. The primary outcome was incidence of extubation failure in patients who were oversedated (defined by State Behavioral Scale (SBS) score of -3 or -2) within 72 hours of extubation compared to patients who were not oversedated. Secondary outcomes included evaluation of risk factors associated with oversedation and extubation failure. The primary endpoint was evaluated using a one-sided chi-square test at a significance level of p = 0.05. The risk factor analysis utilized univariate and multivariate logistic regression. Covariance-adjusted odds ratios and their corresponding 95% confidence intervals were estimated for the final set of risk factors in the models. Results: One hundred eight patients were included in the analysis, representing 62 oversedated patients and 46 non-oversedated patients. Groups were well matched with regards to baseline characteristics. Most patients received fentanyl and midazolam continuous infusions. There was no difference in extubation failure in oversedated patients versus non-oversedated patients [14 patients (22.58%) versus 7 patients (15.22%), respectively; p = 0.33]. After adjusting for potential risk factors, patients with lower Glasgow Coma Scale (GCS) scores prior to intubation (OR 1.15; 95% CI 0.74-0.97) and higher maximum benzodiazepine dose per day (OR 1.93; 95% CI 1.01-3.71) were associated with an increased risk of oversedation. Longer durations of mechanical ventilation (OR 1.10; 95% CI 0.97-1.25) and higher maximum benzodiazepine dose per day (OR 1.47; 95% CI 0.71-3.05) were associated with an increased risk of extubation failure. Conclusions: Rates of extubation failure were similar among oversedated versus non-oversedated patients. Higher maximum benzodiazepine dose per day was associated with increased risk for oversedation and extubation failure. Benzodiazepine dosing should potentially be re-evaluated in this population.