• Sandeep Tripathi, Eugene Laksana, Michael C McCrory, Stephanie Hsu, Alice X Zhou, Kimberly Burkiewicz, David R Ledbetter, Melissa D Aczon, Sareen Shah, Linda Siegel, Nina Fainberg, Katie R Morrow, Michael Avesar, Harsha K Chandnani, Jui Shah, Charlene Pringle, and Meredith C Winter.
• Pediatric Intensive Care, OSF HealthCare, Children's Hospital of Illinois/University of Illinois College of Medicine, Peoria, IL.
• Pediatr Crit Care Me. 2023 Jun 1; 24 (6): 463472463-472.

ObjectivesTo describe the doses of opioids and benzodiazepines administered around the time of terminal extubation (TE) to children who died within 1 hour of TE and to identify their association with the time to death (TTD).DesignSecondary analysis of data collected for the Death One Hour After Terminal Extubation study.SettingNine U.S. hospitals.PatientsSix hundred eighty patients between 0 and 21 years who died within 1 hour after TE (2010-2021).Measurements And Main ResultsMedications included total doses of opioids and benzodiazepines 24 hours before and 1 hour after TE. Correlations between drug doses and TTD in minutes were calculated, and multivariable linear regression performed to determine their association with TTD after adjusting for age, sex, last recorded oxygen saturation/F io2 ratio and Glasgow Coma Scale score, inotrope requirement in the last 24 hours, and use of muscle relaxants within 1 hour of TE. Median age of the study population was 2.1 years (interquartile range [IQR], 0.4-11.0 yr). The median TTD was 15 minutes (IQR, 8-23 min). Forty percent patients (278/680) received either opioids or benzodiazepines within 1 hour after TE, with the largest proportion receiving opioids only (23%, 159/680). Among patients who received medications, the median IV morphine equivalent within 1 hour after TE was 0.75 mg/kg/hr (IQR, 0.3-1.8 mg/kg/hr) ( n = 263), and median lorazepam equivalent was 0.22 mg/kg/hr (IQR, 0.11-0.44 mg/kg/hr) ( n = 118). The median morphine equivalent and lorazepam equivalent rates after TE were 7.5-fold and 22-fold greater than the median pre-extubation rates, respectively. No significant direct correlation was observed between either opioid or benzodiazepine doses before or after TE and TTD. After adjusting for confounding variables, regression analysis also failed to show any association between drug dose and TTD.ConclusionsChildren after TE are often prescribed opioids and benzodiazepines. For patients dying within 1 hour of TE, TTD is not associated with the dose of medication administered as part of comfort care.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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