Emergency Physician-Administered Sedation for Thoracostomy in Children With Pleuropneumonia.
Journal
Pediatric emergency care
ISSN: 1535-1815
Titre abrégé: Pediatr Emerg Care
Pays: United States
ID NLM: 8507560
Informations de publication
Date de publication:
01 Dec 2021
01 Dec 2021
Historique:
pubmed:
14
1
2020
medline:
18
12
2021
entrez:
14
1
2020
Statut:
ppublish
Résumé
Thoracostomy drainage is sometimes required in children with pleuropneumonia who have large parapneumonic effusion. This procedure is usually performed under sedation. The aim was to report sedation adverse events (SAEs) in pneumonia patients sedated for thoracostomy by pediatric emergency physicians. A retrospective cohort study was conducted. The medical records of all emergency department patients who underwent thoracostomy between January 1, 2012, and December 31, 2018, were extracted. Study outcomes were SAEs that required intervention. Pigtail catheters were placed by chest surgeons in 28 children with a median age of 2 years (interquartile range [IQR], 1-5 years). All the thoracostomies were successfully performed under sedation performed by 11 pediatric emergency physicians. The median amount of fluid drained after catheter insertion was 200 mL (IQR, 100-500 mL). The median pleural fluid PH was 7.0 (IQR, 6.9-7.3), and the median white blood cell count was 34,600 per mm3 (IQR, 11,800-109,000 per mm3). Thirteen patients (46.4%) were sedated with a total median dose of 3 mg/kg of ketamine (IQR, 2-4 mg/kg) and 0.2 mg/kg of midazolam (IQR, 0.2-0.3 mg/kg); 11 patients (39.3%) were treated with 1 mg/kg of ketamine (IQR, 0.5-2 mg/kg) and 3 mg/kg of propofol (IQR, 2-4 mg/kg). Four patients (14.3%) were treated exclusively with 4 mg/kg of ketamine (IQR, 3-5 mg/kg). Nine oxygen desaturations required intervention; 1 was associated with laryngospasm and 1 with apnea. All the SAEs were successfully managed. No cases of hypotension, bradycardia, airway obstruction, or pulmonary aspiration were recorded. The first series of pneumonia patients sedated for thoracostomy by pediatric emergency physicians is reported. Sedation was safely performed in this cohort.
Sections du résumé
BACKGROUND
BACKGROUND
Thoracostomy drainage is sometimes required in children with pleuropneumonia who have large parapneumonic effusion. This procedure is usually performed under sedation. The aim was to report sedation adverse events (SAEs) in pneumonia patients sedated for thoracostomy by pediatric emergency physicians.
METHODS
METHODS
A retrospective cohort study was conducted. The medical records of all emergency department patients who underwent thoracostomy between January 1, 2012, and December 31, 2018, were extracted. Study outcomes were SAEs that required intervention.
RESULTS
RESULTS
Pigtail catheters were placed by chest surgeons in 28 children with a median age of 2 years (interquartile range [IQR], 1-5 years). All the thoracostomies were successfully performed under sedation performed by 11 pediatric emergency physicians. The median amount of fluid drained after catheter insertion was 200 mL (IQR, 100-500 mL). The median pleural fluid PH was 7.0 (IQR, 6.9-7.3), and the median white blood cell count was 34,600 per mm3 (IQR, 11,800-109,000 per mm3). Thirteen patients (46.4%) were sedated with a total median dose of 3 mg/kg of ketamine (IQR, 2-4 mg/kg) and 0.2 mg/kg of midazolam (IQR, 0.2-0.3 mg/kg); 11 patients (39.3%) were treated with 1 mg/kg of ketamine (IQR, 0.5-2 mg/kg) and 3 mg/kg of propofol (IQR, 2-4 mg/kg). Four patients (14.3%) were treated exclusively with 4 mg/kg of ketamine (IQR, 3-5 mg/kg). Nine oxygen desaturations required intervention; 1 was associated with laryngospasm and 1 with apnea. All the SAEs were successfully managed. No cases of hypotension, bradycardia, airway obstruction, or pulmonary aspiration were recorded.
CONCLUSIONS
CONCLUSIONS
The first series of pneumonia patients sedated for thoracostomy by pediatric emergency physicians is reported. Sedation was safely performed in this cohort.
Identifiants
pubmed: 31929389
pii: 00006565-202112000-00092
doi: 10.1097/PEC.0000000000001975
doi:
Substances chimiques
Hypnotics and Sedatives
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1209-e1212Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure: The authors declare no conflict of interest.
Références
Balfour-Lynn IM, Abrahamson E, Cohen G, et al; Paediatric Pleural Diseases Subcommittee of the BTS Standards of Care Committee. BTS guidelines for the management of pleural infection in children. Thorax . 2005;(60 suppl 1):i1–i21.
Krenke K, Urbankowska E, Urbankowski T, et al. Clinical characteristics of 323 children with parapneumonic pleural effusion and pleural empyema due to community acquired pneumonia. J Infect Chemother . 2016;22:292–297.
Grijalva CG, Nuorti JP, Zhu Y, et al. Increasing incidence of empyema complicating childhood community acquired pneumonia in the United States. Clin Infect Dis . 2010;50:805–813.
Bradley JS, Byington CL, Shah SS, et al; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the pediatric infectious diseases society and the infectious diseases society of America. Clin Infect Dis . 2011;53:e25–e76.
Petel D, Li P, Emil S. Percutaneous pigtail catheter versus tube thoracostomy for pediatric empyema: a comparison of outcomes. Surgery . 2013;154:655–660.
Lin CH, Lin WC, Chang JS. Comparison of pigtail catheter with chest tube for drainage of parapneumonic effusion in children. Pediatr Neonatol . 2011;52:337–341.
Lewis MR, Micic TA, Doull IJM, et al. Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children - 16-year, single-centre experience of radiologically placed drains. Pediatr Radiol . 2018;48:1410–1416.
Green SM, Denmark TK, Cline J, et al. Ketamine sedation for pediatric critical care procedures. Pediatr Emerg Care . 2001;17:244–248.
Bhatt M, Kennedy RM, Osmond MH, et al; Consensus Panel on Sedation Research of Pediatric Emergency Research Canada (PERC) and the Pediatric Emergency Care Applied Research Network (PECARN). Consensus-based recommendations for standardizing terminology and reporting adverse events for emergency department procedural sedation and analgesia in children. Ann Emerg Med . 2009;53:426–435.e4.
Shavit I, Bar-Yaakov N, Grossman L, et al. Sedation for children with intraoral injuries in the emergency department: a case-control study. Pediatr Emerg Care . 2014;30:805–807.
Bar Am N, Samuel N, Ben-Lulu H, et al. Procedural sedation in non-intubated children with severe trauma — a single center study. Am J Surg . 2019;218:95–99.
Shavit I, Shavit D, Feldman O, et al. Emergency physician-administered sedation for pneumatic reduction of ileocolic intussusception in children: a case series. J Emerg Med . 2019;56:29–35.
Shavit I, Keidan I, Hoffmann Y, et al. Enhancing patient safety during pediatric sedation: the impact of simulation-based training of nonanesthesiologists. Arch Pediatr Adolesc Med . 2007;161:740–743.
Ben-Ari M, Chayen G, Steiner IP, et al. The effect of in situ simulation training on the performance of tasks related to patient safety during sedation. J Anesth . 2018;32:300–304.
Scheier E, Gadot C, Leiba R, et al. Sedation with the combination of ketamine and propofol in a pediatric ED: a retrospective case series analysis. Am J Emerg Med . 2015;33:815–817.
Samuel N, Shavit I, Steiner IP, et al. A proactive approach to ED information technology: the case of pediatric procedural sedation. Am J Emerg Med . 2016;34:1901–1902.
Krauss B, Green SM. Procedural sedation and analgesia in children. Lancet . 2006;367:766–780.
Kaji AH, Schriger D, Green S. Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies. Ann Emerg Med . 2014;64:292–298.
Green SM, Rothrock SG, Harris T, et al. Intravenous ketamine for pediatric sedation in the emergency department: safety and efficacy with 156 cases. Acad Emerg Med . 1998;5:971–976.
Bhatt M, Johnson DW, Chan J, et al. Risk factors for adverse events in emergency department procedural sedation for children. JAMA Pediatr . 2017;171:957–964.