TY - JOUR T1 - Withdrawal Assessment Tool-1 Monitoring in PICU: A Multicenter Study on Iatrogenic Withdrawal Syndrome. JF - Pediatr Crit Care Med Y1 - 2017 A1 - Amigoni, Angela A1 - Mondardini, Maria Cristina A1 - Vittadello, Ilaria A1 - Zaglia, Federico A1 - Rossetti, Emanuele A1 - Vitale, Francesca A1 - Ferrario, Stefania A1 - Savron, Fabio A1 - Coffaro, Giancarlo A1 - Brugnaro, Luca A1 - Amato, Roberta A1 - Wolfler, Andrea A1 - Franck, Linda S KW - Adolescent KW - Analgesics KW - Child KW - Child, Preschool KW - Critical Care KW - Female KW - Humans KW - Hypnotics and Sedatives KW - Iatrogenic Disease KW - Infant KW - Infant, Newborn KW - Intensive Care Units, Pediatric KW - Italy KW - Logistic Models KW - Male KW - Prospective Studies KW - Respiration, Artificial KW - Substance Withdrawal Syndrome AB -

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' 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'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.

VL - 18 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28157809?dopt=Abstract ER - TY - JOUR T1 - The Importance of Mortality Risk Assessment: Validation of the Pediatric Index of Mortality 3 Score. JF - Pediatr Crit Care Med Y1 - 2016 A1 - Wolfler, Andrea A1 - Osello, Raffaella A1 - Gualino, Jenny A1 - Calderini, Edoardo A1 - Vigna, Gianluca A1 - Santuz, Pierantonio A1 - Amigoni, Angela A1 - Savron, Fabio A1 - Caramelli, Fabio A1 - Rossetti, Emanuele A1 - Cecchetti, Corrado A1 - Corbari, Maurizio A1 - Piastra, Marco A1 - Testa, Raffaele A1 - Coffaro, Giancarlo A1 - Stancanelli, Giusi A1 - Gitto, Eloisa A1 - Amato, Roberta A1 - Prinelli, Federica A1 - Salvo, Ida AB -

OBJECTIVE: To evaluate the performance of the newest version of the Pediatric Index of Mortality 3 score and compare it with the Pediatric Index of Mortality 2 in a multicenter national cohort of children admitted to PICU.

DESIGN: Retrospective, prospective cohort study.

SETTING: Seventeen Italian PICUs.

PATIENTS: All children 0 to 15 years old admitted in PICU from January 2010 to October 2014.

INTERVENTIONS: None.

MEASUREMENT AND MAIN RESULTS: Eleven thousand one hundred nine children were enrolled in the study. The mean Pediatric Index of Mortality 2 and 3 values of 4.9 and 3.9, respectively, differed significantly (p < 0.05). Overall mortality rate was 3.9%, and the standardized mortality ratio was 0.80 for Pediatric Index of Mortality 2 and 0.98 for Pediatric Index of Mortality 3 (p < 0.05). The area under the curve of the receiver operating characteristic curves was similar for Pediatric Index of Mortality 2 and Pediatric Index of Mortality 3. The Hosmer-Lemeshow test was not significant for Pediatric Index of Mortality 3 (p = 0.21) but was highly significant for Pediatric Index of Mortality 2 (p < 0.001), which overestimated death mainly in high-risk categories.

CONCLUSIONS: Mortality indices require validation in each country where it is used. The new Pediatric Index of Mortality 3 score performed well in an Italian population. Both calibration and discrimination were appropriate, and the score more accurately predicted the mortality risk than Pediatric Index of Mortality 2.

VL - 17 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26825046?dopt=Abstract ER -