Association of Obesity With Sedative Dosing, Sedative Response, and Clinical Outcomes in Mechanically Ventilated Critically Ill Children
OBJECTIVES:. This study aimed to investigate the impact of obesity on the use of analgesics and sedatives, rates of iatrogenic withdrawal syndrome (IWS), and outcomes in mechanically ventilated pediatric patients. Additionally, it sought to assess whether a nurse-implemented sedation protocol would...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-02-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000001214 |
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| author | Shan L. Ward, MD, MAS Onella S. Dawkins-Henry, MS Lisa A. Asaro, MS David Wypij, PhD Martha A. Q. Curley, RN, PhD for the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators |
| author_facet | Shan L. Ward, MD, MAS Onella S. Dawkins-Henry, MS Lisa A. Asaro, MS David Wypij, PhD Martha A. Q. Curley, RN, PhD for the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators |
| author_sort | Shan L. Ward, MD, MAS |
| collection | DOAJ |
| description | OBJECTIVES:. This study aimed to investigate the impact of obesity on the use of analgesics and sedatives, rates of iatrogenic withdrawal syndrome (IWS), and outcomes in mechanically ventilated pediatric patients. Additionally, it sought to assess whether a nurse-implemented sedation protocol would be equally effective for children with and without obesity.
DESIGN:. Secondary analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) pediatric multicenter clinical trial.
SETTING:. Thirty-one U.S. PICUs.
PATIENTS:. Children 1–17 years old, categorized as with or without obesity according to World Health Organization and Centers for Disease Control and Prevention criteria.
INTERVENTIONS:. None.
MEASUREMENTS AND MAIN RESULTS:. The study assessed various factors including medication exposure, adequacy of pain and sedation management, IWS rates, and clinical outcomes. Obesity occurred in 22% of patients. Obesity did not influence choice of opiate, but it led to extended exposure to these medications. There were no differences in dosing per kilogram of admission weight, resulting in significantly higher daily and cumulative doses in those with obesity. In the protocolized sedation arm, patients with obesity received significantly higher median opiate doses compared with the nonobesity protocolized sedation group. IWS rates did not differ; however, protocolized sedation obesity patients experienced more instances of inadequate sedation, longer time to extubation readiness, longer duration of mechanical ventilation and PICU stay, and higher 28-day in-hospital mortality than the protocolized sedation nonobesity group. These weight-based differences were not noted in the usual care arm.
CONCLUSIONS:. This study underscores the significance of accounting for body habitus when selecting and dosing opiates in children with acute respiratory failure. Obesity had substantial impact on medication exposure and clinical outcomes, particularly within a structured, protocolized sedation regimen. Further research is warranted to explore the intricate relationship between medication dosing and clinical outcomes in children with obesity. |
| format | Article |
| id | doaj-art-59d02df7d8b84461ba5fc57d0711689a |
| institution | DOAJ |
| issn | 2639-8028 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj-art-59d02df7d8b84461ba5fc57d0711689a2025-08-20T02:45:43ZengWolters KluwerCritical Care Explorations2639-80282025-02-0172e121410.1097/CCE.0000000000001214202502000-00006Association of Obesity With Sedative Dosing, Sedative Response, and Clinical Outcomes in Mechanically Ventilated Critically Ill ChildrenShan L. Ward, MD, MAS0Onella S. Dawkins-Henry, MS1Lisa A. Asaro, MS2David Wypij, PhD3Martha A. Q. Curley, RN, PhD4for the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators1 Department of Pediatrics, Division of Critical Care, UCSF Benioff Children’s Hospitals, San Francisco and Oakland, CA.2 Department of Cardiology, Boston Children’s Hospital, Boston, MA.2 Department of Cardiology, Boston Children’s Hospital, Boston, MA.2 Department of Cardiology, Boston Children’s Hospital, Boston, MA.5 Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.OBJECTIVES:. This study aimed to investigate the impact of obesity on the use of analgesics and sedatives, rates of iatrogenic withdrawal syndrome (IWS), and outcomes in mechanically ventilated pediatric patients. Additionally, it sought to assess whether a nurse-implemented sedation protocol would be equally effective for children with and without obesity. DESIGN:. Secondary analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) pediatric multicenter clinical trial. SETTING:. Thirty-one U.S. PICUs. PATIENTS:. Children 1–17 years old, categorized as with or without obesity according to World Health Organization and Centers for Disease Control and Prevention criteria. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. The study assessed various factors including medication exposure, adequacy of pain and sedation management, IWS rates, and clinical outcomes. Obesity occurred in 22% of patients. Obesity did not influence choice of opiate, but it led to extended exposure to these medications. There were no differences in dosing per kilogram of admission weight, resulting in significantly higher daily and cumulative doses in those with obesity. In the protocolized sedation arm, patients with obesity received significantly higher median opiate doses compared with the nonobesity protocolized sedation group. IWS rates did not differ; however, protocolized sedation obesity patients experienced more instances of inadequate sedation, longer time to extubation readiness, longer duration of mechanical ventilation and PICU stay, and higher 28-day in-hospital mortality than the protocolized sedation nonobesity group. These weight-based differences were not noted in the usual care arm. CONCLUSIONS:. This study underscores the significance of accounting for body habitus when selecting and dosing opiates in children with acute respiratory failure. Obesity had substantial impact on medication exposure and clinical outcomes, particularly within a structured, protocolized sedation regimen. Further research is warranted to explore the intricate relationship between medication dosing and clinical outcomes in children with obesity.http://journals.lww.com/10.1097/CCE.0000000000001214 |
| spellingShingle | Shan L. Ward, MD, MAS Onella S. Dawkins-Henry, MS Lisa A. Asaro, MS David Wypij, PhD Martha A. Q. Curley, RN, PhD for the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators Association of Obesity With Sedative Dosing, Sedative Response, and Clinical Outcomes in Mechanically Ventilated Critically Ill Children Critical Care Explorations |
| title | Association of Obesity With Sedative Dosing, Sedative Response, and Clinical Outcomes in Mechanically Ventilated Critically Ill Children |
| title_full | Association of Obesity With Sedative Dosing, Sedative Response, and Clinical Outcomes in Mechanically Ventilated Critically Ill Children |
| title_fullStr | Association of Obesity With Sedative Dosing, Sedative Response, and Clinical Outcomes in Mechanically Ventilated Critically Ill Children |
| title_full_unstemmed | Association of Obesity With Sedative Dosing, Sedative Response, and Clinical Outcomes in Mechanically Ventilated Critically Ill Children |
| title_short | Association of Obesity With Sedative Dosing, Sedative Response, and Clinical Outcomes in Mechanically Ventilated Critically Ill Children |
| title_sort | association of obesity with sedative dosing sedative response and clinical outcomes in mechanically ventilated critically ill children |
| url | http://journals.lww.com/10.1097/CCE.0000000000001214 |
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