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Variations In Analgesic, Anxiolytic And Sedative Practices Among Trauma And Non-trauma Critically Ill Children
Megan E Cunningham1, Michael D Chance2, Huirong Zhu2, Sara C Fallon1, Dustin M Hipp2, Sohail R Shah1, *Bindi J Naik-Mathuria1, Nicholas A Ettinger2, *Adam M Vogel1
1Baylor College of Medicine, Houston, TX;2Texas Children's Hospital, Houston, TX

Background (issue):
Traumatically injured, critically ill, pediatric patients have unique medical and surgical needs compared to their non-traumatic counterparts. There is a paucity of data concerning management of pain, anxiety, sedation and delirium in these patients. Methods:
Mechanically ventilated children in the intensive care unit (ICU) were identified from the PHIS 2017 database and were divided into trauma, surgical, and medical cohorts. Excluded were those with NICU admission, underlying pulmonary or diaphragmatic conditions, ventilation prior to admission or <24 hours, ECMO, and cardiac surgeries. Results are presented as percent and median [IQR]. Findings:
There were 4,488 children identified from 47 hospitals. Median age was 3[0-10] years, 58% were male, and 26% had an extreme risk of mortality. The trauma cohort had more male patients (64% vs 57% vs 56%) and were older (8[4-14] vs 5[1-12] vs 1[0-6] years; p<0.01) compared to surgery and medical. Trauma had higher mortality (11.7% vs 2.4% vs 5.4%; p<0.01) and tracheostomy (3.4% vs 0.7% vs 1.7%; p<0.01) rates, but fewer nosocomial infections (3.4% vs 7.6% vs 7.0%; p<0.01). Exposure to α2 agonists, antipsychotics, GABA agonists, and opioids was significantly different among all three cohorts over a 30-day period (Figure 1). Conclusions (implications for practice):Traumatically injured children who are critically ill are unique compared to other critically ill pediatric populations, and these differences may extend to the pharmacologic management of analgesia, sedation, anxiety, and delirium.


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