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Analgesia-sedation in PICU and neurological outcome: a secondary analysis of long-term neuropsychological follow-up in meningococcal septic shock survivors*.
- Source :
-
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2014 Mar; Vol. 15 (3), pp. 189-96. - Publication Year :
- 2014
-
Abstract
- Objectives: To investigate whether analgesic and sedative drug use during PICU treatment is associated with long-term neurodevelopmental outcome in children who survived meningococcal septic shock.<br />Design: This study concerned a secondary analysis of data from medical and psychological follow-up of a cross-sectional cohort of all consecutive surviving patients with septic shock and purpura requiring intensive care treatment between 1988 and 2001 at the Erasmus MC-Sophia Children's Hospital. At least 4 years after PICU admission, these children showed impairments on several domains of neuropsychological functioning. In the present study, type, number, and dose of sedatives and analgesics were retrospectively evaluated.<br />Setting: Tertiary care university hospital.<br />Patients: Seventy-seven meningococcal septic shock survivors (median age, 2.1 yr).<br />Interventions: None.<br />Measurements and Main Results: Forty-five patients (58%) received one or more analgesic and/or sedative drugs during PICU admission, most commonly benzodiazepines (n = 39; 51%), followed by opioids (n = 23; 30%). In total, 12 different kinds of analgesic or sedative drugs were given. The use and dose of opioids were significantly associated with poor test outcome on full-scale intelligence quotient (p = 0.02; Z = -2.28), verbal intelligence quotient (p = 0.02; Z = -2.32), verbal intelligence quotient subtests (verbal comprehension [p = 0.01; Z = -2.56] and vocabulary [p = 0.01; Z = -2.45]), and visual attention/executive functioning (Trial Making Test part B) (p = 0.03; Z = -2.17). In multivariate analysis adjusting for patient and disease characteristics, the use of opioids remained significant on most neuropsychological tests.<br />Conclusions: The use of opioids during PICU admission was significantly associated with long-term adverse neuropsychological outcome independent of severity of illness scores in meningococcal septic shock survivors.
- Subjects :
- Adolescent
Analgesia methods
Child
Cohort Studies
Conscious Sedation methods
Cross-Sectional Studies
Female
Follow-Up Studies
Humans
Intensive Care Units, Pediatric
Male
Meningococcal Infections drug therapy
Mental Disorders diagnosis
Neuropsychological Tests
Retrospective Studies
Shock, Septic drug therapy
Survivors
Tertiary Care Centers
Analgesics adverse effects
Hypnotics and Sedatives adverse effects
Meningococcal Infections microbiology
Mental Disorders chemically induced
Shock, Septic microbiology
Subjects
Details
- Language :
- English
- ISSN :
- 1529-7535
- Volume :
- 15
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
- Publication Type :
- Academic Journal
- Accession number :
- 24366510
- Full Text :
- https://doi.org/10.1097/PCC.0000000000000044