THE USE OF PROPOFOL SEDATION IN PAEDIATRIC INTENSIVE CARE UNIT
Svensson ML, Lindberg L. Nurs Crit Care. 2012;17(4):198-203.
In this prospective study, the researchers aimed to evaluate and report the experience with the use of continuous intravenous propofol sedation in a pediatric intensive care unit. In addition, the researchers sought to find safe routines for the use of propofol in the pediatric intensive care unit and the development of propofol infusion syndrome (PRIS). This was a single-institution study.
Data were collected from 174 (18.2%) of 955 charts. The age range was 2 months to 16 years, with the median age being 2 years 10 months. Data were recorded before and within 6 hours of infusion completion. Data collected included mean arterial blood pressure, central venous pressure, lactate, base excess, pH, oxygen saturation, blood glucose, total parental nutrition, and triglycerides. The subjects were differentiated between those requiring short- and long-term infusion (>48 hours of infusion) and low and high dose (>3 mg/kg per hour).
None of the subjects developed signs of PRIS, and neither dose nor length of infusion was found to be related to adverse metabolic issues or circulatory failure. Eight patients had increased lactated concentration, but had good outcomes.
The authors concluded that propofol in their population had a low risk of PRIS and no metabolic or circulatory adverse effects.
RANDOMISED TRAIL OF VOLUME-TARGETED VENTILATION VERSUS PRESSURE-LIMITED VENTILATION IN ACUTE RESPPIRATORY FAILURE IN PREMATURELY BORN INFANTS.
Chowdhury O, Patel DS, Hannam S, et al. Neonatology. 2013;104:290-294.
The objective of this randomized trial was to determine if volume-targeted ventilation (VTV) compared with pressure-limited ventilation (PLV) reduced the time to reach weaning criteria in premature infants born with acute respiratory distress and there was if any difference as explained by better respiratory muscle strength and/or lower work of breathing (WOB).
Forty infants with a mean gestational age of 27 weeks (range, 23-33 weeks) were recruited for this study. They were randomized to receive either VTV or PLV. The primary outcome was the time to achieve pre-specific weaning criteria. Respiratory muscle strength was assessed by the measurement of maximum inflation, and expiratory pressures and WOB were assessed with transdiaphragmatic pressure time product. Other outcomes that were reported included duration of ventilation, occurrence of patient ductus arteriosus, pneumothorax, intraventricular hemorrhage, and episodes of hypocarbia.
The authors found the time taken to achieve weaning criteria was similar for the 2 groups (median, 14 hours [VTV] vs 23 hours [PLV]). They found no significant differences between the groups with respiratory muscle strength, WOB, or other outcomes other than the VTV group had decreased episode of hypocarbia (8 vs 19; P < .001).