• Deanna Caldwell, Jonathan Wong, and Mark Duffett.
• , PharmD, ACPR, RPh, was, at the time of this study, a pharmacy resident at McMaster Children's Hospital, Hamilton, Ontario. She is now with the Department of Pharmacy, London Health Sciences, London, Ontario, BScPharm, PharmD, ACPR, RPh, is with the Department of Pharmacy, McMaster Children's Hospital, Hamilton, Ontario, BSc(Pharm), MSc, PhD, ACPR, RPh, is with the Department of Pediatrics, McMaster University, and the Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario.
• Can J Hosp Pharm. 2020 Mar 1; 73 (2): 125-132.

BackgroundProviding safe and effective sedation to critically ill children is challenging. The assessment, prevention, and treatment of symptoms of iatrogenic withdrawal are critical aspects of sedation practice.ObjectiveTo describe the use of sedative medications in critically ill children at McMaster Children's Hospital.MethodsThis retrospective observational study included children admitted over a 12-month period who survived their illness and who received sedation and at least 48 h of invasive ventilation. We collected data from the time of admission to the pediatric intensive care unit to 3 days after discontinuation of sedation.ResultsWe included 67 children. The median age was 1.6 (interquartile range [IQR] 0.2-6.2) years, and respiratory illnesses were the most common reason for admission (41 [61%]). The children received invasive ventilation for a median of 7 (IQR 4-11) days and sedation for a median of 12 (IQR 6-20) days. Sixty-six children (99%) received an opioid, and all received a benzodiazepine, with median cumulative doses of 14 (IQR 5-27) mg/kg morphine equivalents and 15 (IQR 6-32) mg/kg midazolam equivalents. Dexmedetomidine was given to 31 children (46%), for a median of 8 (IQR 4-12) days. Most children (67%) received sedation after extubation (median duration 7 [IQR 4-14] days). In addition, 32 children (48%) continued to receive sedative medications after transfer to the ward, for a median of 6 (IQR 4-13) days. Forty-two children (63%) had at least one Withdrawal Assessment Tool-1 (WAT-1) score indicative of iatrogenic withdrawal. Children who experienced withdrawal were exposed to more opioids and more benzodiazepines, both per day and overall, and for longer periods.ConclusionsThe children in this study were exposed to multiple sedatives, and many continued to receive these medications for an extended period after discontinuation of mechanical ventilation. Iatrogenic withdrawal was common and represents an important opportunity to improve children's recovery after critical illness.2020 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.

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