Pharmacodynamics Parameters Determine Analgesic and Sedative Drug Dosing during Neonatal and Pediatric Extracorporeal Membrane Oxagenation
Abstract
Extracorporeal Membrane Oxygenation (ECMO) is a complex highly specialized care facility used in neonates and children with reversible circulatory and/or ventilator failure. Aim of our study to evaluate the effect of implementation of the protocolized use of pain, sedation and withdrawal scores on analgosedative drug dosing in ECMO patients.From October 2010 to January 2015 ECMO was performed in 20 patients (12 neonates, 8 children)using a Bio-Medicos centrifugal pump.
Patients were stratified according to standardized scoring of pain and sedation in two groups: period I (n=14) standardized scoring without protocolized use of analgosedation and period II (n=6) standardized scoring with protocolized use of analgosedative drugs based on validated pain and sedation scores. Pharmacodynamic parameters of analgosedative drugs consisted of COMFORT behavior scale (COMFORT-B) and Sophia Observation Withdrawal Symptoms-scale(SOS).
Mean (SEM) cumulative daily dose of midazolam (mg.kg-1.day-1) and sufentanil (μg.kg-1.day-1), and total number of analgosedative drugs per patient were compared between groups using the Student's t-test and its Welch modification with the 95% confidence interval (CI).COMFORT-B scores were within target range (11-22) in 62% of all measurements of 14 patients, while 36% of scores were considered to identify over sedation (<11) in 5 patients. 12.5% of two consecutive SOS GREATER-THAN OR EQUAL TO4 suggested withdrawal in 10 patients (7 patients in period I, three patients in period II).Total number of analgosedative drugs per patient decreased significantly in period II from a median of 8 (IQR) (3-14) to 5 (3-7) in period I (P=0.047). The mean cumulative dose of midazolam decreased from 5.7 (SEM 0.6) to 3.7 (SEM 0.44) mg.kg-1.day-1 (P=0.053), and the mean cumulative dose of sufentanil from 22.3(SEM 3.63) to 8.1 (SEM 1.27) ug.kg-1. day-1 (P=0.002).