The objective of the study is to evaluate the effects of halogenated gases on sedation and analgesia, to describe the tolerance and to determine the risk factors for failure, in pediatric intensive care patients during prolonged sedation. This study will be based on the medical records of patients hospitalized between 2015 and 2020.
Sedation is a major therapeutic element in patients in intensive care under artificial ventilation, in order to allow their comfort and patient-ventilator synchronization. The use of benzodiazepines in combination with opioids is common practice. However, during prolonged sedation, the effects wane, then the doses must be increased, responsible for an increase in the incidence of a significant withdrawal syndrome in the recovery phase, a source of delay in extubation or early reintubation. The use of halogenated anesthetic gases is now possible in pediatric intensive care in these patients on artificial ventilation. Their efficacy and tolerance in prolonged use must be evaluated. Their use could improve the sedative effects, reduce the doses of benzodiazepines and opioids used, and reduce unwanted effects in terms of withdrawal syndrome. The objective of the study is to evaluate the effects of halogenated gases on sedation and analgesia, to describe the tolerance and to determine the risk factors for failure, in pediatric intensive care patients during prolonged sedation. This study will be based on the medical records of patients hospitalized between 2015 and 2020.
Study Type
OBSERVATIONAL
Enrollment
50
Hôpital Bicêtre
Le Kremlin-Bicêtre, France
Hôpital Armand Trousseau
Paris, France
Dosages of hypnotics first 24 hours following the introduction of halogens
Show a reduction in hypnotics dosages, calculated in Midazolam equivalent in µg / kg / h, during the first 24 hours after the introduction of halogens. A decrease will be significant if it is greater than 20% compared to the basal level before initiation of the halogens.
Time frame: Day 0
Dosages of opioids in the 24 hours following the introduction of halogens
Show a reduction \> 20% in opioids dosages (calculated in morphine equivalent, in µg / kg / h, in the 24 hours following the introduction of halogens.
Time frame: Day 0
Dosages of ketamine within 24 hours of the introduction of halogens
Show a reduction \>20% in ketamine dosages within 24 hours of the introduction of halogens (mg / kg / h).
Time frame: Day 0
Morphinic / hypnotic dosages at the end of halogenated use
Show a reduction \> 20% in morphinic / hypnotic dosages at the end of halogenated use (\> 24 hours).
Time frame: Day 0
Clinical sedation score
COMFORT BEHAVIOUR scale. Measures pain and excess sedation in intensive care, starting in the neonatal period. Score: from 6 to 30 : Excess sedation: 6 to 10 Comfortable child, sedated without excess: 11 to 17 Child in borderline condition, possible pain: 17 to 22 Child clearly uncomfortable, painful: 23 to 30
Time frame: Day 0
Hypnotics / sedatives / curares dosages in populations of ARDS patients at the end of the use of halogens
Show a reduction\> 20% in hypnotics / sedatives / curares dosages (µg/kg/h) in populations of Acute Respiratory Distress Syndrome patients (ARDS patients) with and without extracorporeal membrane oxygenation (ECMO) at the end of the use of halogens (\> 24 hours).
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Time frame: Day 0
Ventilatory parameters in patients with ARDS during the period of halogen use
Show a reduction \> 20% in ventilatory parameters (PEEP in mmHg, Tidal volume in ml, PaO2/FiO2 ratio) in patients with ARDS during the period of halogen use (\<24 hours).
Time frame: Day 0
Total duration of sedation, analgesia and curarization
Determine the total duration of sedation, analgesia and curarization.
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Halogenated failure criteria
Comparison of patients who shown an improvement of the COMFORT B scale 24 hours after introducing halogenated between patients who shown no significant reduction of COMFORT B scale.
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Withdrawal syndrome: morphine and hypnotics
Determine the proportion of withdrawal syndrome : morphine and hypnotics in %.
Time frame: Day 0
Tachyphylaxis to halogenated
Withdrawal syndrome within 24 hours of stopping halogenated: proportion of tachyphylaxis to halogenated.
Time frame: Day 0
Adverse effects of secondary to prolonged administration of Sevoflurane or Isoflurane
Describe the proportions of side effects: Malignant hyperthermia, Arterial hypotension, Tachycardia, Bradypnea or apnea, Bronchospasm, Arrhythmias, Cytolytic hepatitis, Chills, nausea, vomiting upon awakening, Irritation of the respiratory tract, Headache.
Time frame: Day 0