@article {10490, title = {Withdrawal Assessment Tool-1 Monitoring in PICU: A Multicenter Study on Iatrogenic Withdrawal Syndrome.}, journal = {Pediatr Crit Care Med}, volume = {18}, year = {2017}, month = {2017 02}, pages = {e86-e91}, abstract = {

OBJECTIVES: Withdrawal syndrome is an adverse reaction of analgesic and sedative therapy, with a reported occurrence rate between 17\% and 57\% in critically ill children. Although some factors related to the development of withdrawal syndrome have been identified, there is weak evidence for the effectiveness of preventive and therapeutic strategies. The main aim of this study was to evaluate the frequency of withdrawal syndrome in Italian PICUs, using a validated instrument. We also analyzed differences in patient characteristics, analgesic and sedative treatment, and patients{\textquoteright} outcome between patients with and without withdrawal syndrome.

DESIGN: Observational multicenter prospective study.

SETTING: Eight Italian PICUs belonging to the national PICU network Italian PICU network.

PATIENTS: One hundred thirteen patients, less than 18 years old, mechanically ventilated and treated with analgesic and sedative therapy for five or more days. They were admitted in PICU from November 2012 to May 2014.

INTERVENTIONS: Symptoms of withdrawal syndrome were monitored with Withdrawal Assessment Tool-1 scale.

MEASUREMENTS AND MAIN RESULTS: The occurrence rate of withdrawal syndrome was 64.6\%. The following variables were significantly different between the patients who developed withdrawal syndrome and those who did not: type, duration, and cumulative dose of analgesic therapy; duration and cumulative dose of sedative therapy; clinical team judgment about analgesia and sedation{\textquoteright}s difficulty; and duration of analgesic weaning, mechanical ventilation, and PICU stay. Multivariate logistic regression analysis revealed that patients receiving morphine as their primary analgesic were 83\% less likely to develop withdrawal syndrome than those receiving fentanyl or remifentanil.

CONCLUSIONS: Withdrawal syndrome was frequent in PICU patients, and patients with withdrawal syndrome had prolonged hospital treatment. We suggest adopting the lowest effective dose of analgesic and sedative drugs and frequent reevaluation of the need for continued use. Further studies are necessary to define common preventive and therapeutic strategies.

}, keywords = {Adolescent, Analgesics, Child, Child, Preschool, Critical Care, Female, Humans, Hypnotics and Sedatives, Iatrogenic Disease, Infant, Infant, Newborn, Intensive Care Units, Pediatric, Italy, Logistic Models, Male, Prospective Studies, Respiration, Artificial, Substance Withdrawal Syndrome}, issn = {1529-7535}, doi = {10.1097/PCC.0000000000001054}, author = {Amigoni, Angela and Mondardini, Maria Cristina and Vittadello, Ilaria and Zaglia, Federico and Rossetti, Emanuele and Vitale, Francesca and Ferrario, Stefania and Savron, Fabio and Coffaro, Giancarlo and Brugnaro, Luca and Amato, Roberta and Wolfler, Andrea and Franck, Linda S} } @article {8508, title = {Efficacy of ketamine in refractory convulsive status epilepticus in children: a protocol for a sequential design, multicentre, randomised, controlled, open-label, non-profit trial (KETASER01).}, journal = {BMJ Open}, volume = {6}, year = {2016}, month = {2016}, pages = {e011565}, abstract = {

INTRODUCTION: Status epilepticus (SE) is a life-threatening neurological emergency. SE lasting longer than 120 min and not responding to first-line and second-line antiepileptic drugs is defined as {\textquoteright}refractory{\textquoteright} (RCSE) and requires intensive care unit treatment. There is currently neither evidence nor consensus to guide either the optimal choice of therapy or treatment goals for RCSE, which is generally treated with coma induction using conventional anaesthetics (high dose midazolam, thiopental and/or propofol). Increasing evidence indicates that ketamine (KE), a strong N-methyl-d-aspartate glutamate receptor antagonist, may be effective in treating RCSE. We hypothesised that intravenous KE is more efficacious and safer than conventional anaesthetics in treating RCSE.

METHODS AND ANALYSIS: A multicentre, randomised, controlled, open-label, non-profit, sequentially designed study will be conducted to assess the efficacy of KE compared with conventional anaesthetics in the treatment of RCSE in children. 10 Italian centres/hospitals are involved in enrolling 57 patients aged 1 month to 18 years with RCSE. Primary outcome is the resolution of SE up to 24 hours after withdrawal of therapy and is updated for each patient treated according to the sequential method.

ETHICS AND DISSEMINATION: The study received ethical approval from the Tuscan Paediatric Ethics Committee (12/2015). The results of this study will be published in peer-reviewed journals and presented at international conferences.

TRIAL REGISTRATION NUMBER: NCT02431663; Pre-results.

}, issn = {2044-6055}, doi = {10.1136/bmjopen-2016-011565}, author = {Rosati, Anna and Ilvento, Lucrezia and L{\textquoteright}Erario, Manuela and De Masi, Salvatore and Biggeri, Annibale and Fabbro, Giancarlo and Bianchi, Roberto and Stoppa, Francesca and Fusco, Lucia and Pulitan{\`o}, Silvia and Battaglia, Domenica and Pettenazzo, Andrea and Sartori, Stefano and Biban, Paolo and Fontana, Elena and Cesaroni, Elisabetta and Mora, Donatella and Costa, Paola and Meleleo, Rosanna and Vittorini, Roberta and Conio, Alessandra and Wolfler, Andrea and Mastrangelo, Massimo and Mondardini, Maria Cristina and Franzoni, Emilio and McGreevy, Kathleen S and Di Simone, Lorena and Pugi, Alessandra and Mirabile, Lorenzo and Vigevano, Federico and Guerrini, Renzo} }