Paediatric anaesthesia & critical care
Sedative Choice and Neurocognitive Outcomes After Critical Illness in Early Childhood
Main finding · Estimated IQResult — go to the resultAdjusted mean difference −4.1 95% CI −7.3 to −0.9Authors' conclusion
In this study of young children who received more than a week of PICU sedation, the estimated IQ was similar to that of the general population. Children who received an opioid- and benzodiazepine-only strategy scored lower than those who received a strategy that included dexmedetomidine when controlling for socioeconomic status, illness severity, and duration of mechanical ventilation.
Study context
- Population
- Cognitively appropriate children aged 8 years or younger with acute respiratory failure enrolled in the RESTORE trialneurocognitive testing performed
- Participants
- 256 children
- Exposure
- Opioid- and benzodiazepine-only vs Dexmedetomidine
- Outcome
- IQ, estimated by the age-appropriate Vocabulary and Block Design subtests of the Wechsler Intelligence Scale
- Follow-up
- 3 to 8 years after hospitalization
Methodological detailsnested in the RESTORE cluster-randomized clinical trial, multicentre (31 pediatric intensive care units (PICUs)), blinded outcome assessment, Sedation exposure median (IQR) 8 (5 to 14) days at median (IQR) age 1.0 (0.2 to 3.2) years, Neurocognitive testing conducted from February 16, 2015, to November 27, 2018
- Nested in the RESTORE cluster-randomized clinical trial
- Multicentre (31 PICUs)
- Blinded outcome assessment
- Sedation exposure median (IQR) 8 (5 to 14) days at median (IQR) age 1.0 (0.2 to 3.2) years
- Neurocognitive testing conducted from February 16, 2015, to November 27, 2018
Main finding
Estimated IQ · long-term follow-up
Adjusted mean difference
−4.1
95% CI −7.3 to −0.9
P = 0.01
By group
Opioid- and benzodiazepine-only
98.3
mean · SD 11.8
Multiple classes without dexmedetomidine
100.6
mean · SD 14.5
Dexmedetomidine
101.9
mean · SD 13.5
As reported in the abstract
- Overall mean estimated IQ, similar to the published test mean of 100
- 100.3
Observational data: associations, not effects.
Further findings
Age-appropriate global cognitive function (Pediatric Cognitive Performance Category = 1) · at testing
- Children with age-appropriate global cognitive function, of 243 with data
- 228 (93.8%)
Original publication
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