Sedation and Analgesia Influence EEG Monitoring in Pediatric Neurocritical Care,

Publication date: Available online 18 May 2018
Source:Pediatric Neurology
Author(s): Giulia M. Benedetti, Faye S. Silverstein, Stephanie M. Rau, Shannon G. Lester, Marco H. Benedetti, Renée A. Shellhaas
ObjectivesTo assess neuroactive medication use in critically-ill children who require neurologic consultation and to evaluate the associations between administration of these medications and continuous electroencephalography (cEEG) utilization and seizure frequency.MethodsWe evaluated exposure to sedatives, analgesics, anesthetics, and paralytics in consecutive patients (0 days to 18 years) for whom neurological consultation was requested in 3 intensive care units (ICUs) [neonatal (NICU), pediatric (PICU), and cardiothoracic (PCTU)] at one children's hospital. We assessed cEEG usage and seizure incidence in relation to drug exposure.ResultsFrom November 2015-November 2016, 300 consecutive patients were evaluated (93 NICU, 139 PICU, 68 PCTU). Ninety-seven (32%) were receiving ≥1 sedative infusion at the time of consultation [NICU 7(8%), PICU 50(36%), PCTU 40(58%)]; 91(30%) received ≥1 paralytic agent within the preceding 24 hours. cEEG was performed more often for patients treated with sedative infusions (81/97 vs 133/203, p=0.001) and paralytic medications (80/91 vs 134/209, p<0.001) within 24 hours preceding consultation than those who were not. 68/214 (32%) had electrographic seizures (65/68 within initial 24 hours of monitoring); seizures were less common among patients who had received sedative infusions (18/81 vs 51/133, p=0.014). In multivariable analysis of seizure likelihood, only younger age was associated with increased risk (p=0.037).ConclusionsCritically-ill infants and children are frequently treated with sedatives, anesthetics, analgesics, and paralytics. Neuroactive medications limit bedside neurologic assessments and, in this cohort, were associated with increased cEEG usage. Our data underscore the need to study the impact of these medications on clinical care and long-term outcomes.



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