Rate of Self-Extubation in Pediatric Intensive Care Unit Following Administration of Fentanyl, Midazolam and Midazolam-Fentanyl Combination: A Comparative Study

Abstract

<strong><em><span>Background</span></em></strong><br /> <span>Self-extubation is a problem in pediatric intensive care unit (PICU) and can be harmful for children. Level of sedation is a determining factor for self-extubation. The aim of this study was to compare thr rate of self-extubation and duration of ventilation following different sedative modalities.</span><br /> <strong><em><span>Materials and Methods</span></em></strong><br /> <span>This prospective and randomized study was done in Mofid Children Hospital, Tehran, Iran from October 2015 to September 2016. One hundred and fifty seven children from 1 month to 15 years of age with normal consciousness level requiring mechanical ventilation were included.The rate of self-extubation, and duration of ventilation were compared among 3 groups; Midazolam group (n= 50) 0.1 mg/kg/hr, Fentanyl group (n= 50) 2 mcg/kg/hr., and Midazolam-Fentanyl group (n= 57); midazolam 0.05 mg/kg/hr and fentanyl 1 mcg/kg/hr. All administrations were IV. Optimal level of sedation was 2-3 using Ramsay score. </span><br /> <strong><em><span>Results: </span></em></strong><span>One hundred and fifty seven children were studied. The mean age of patients was 4.5 ± 1.5 years with an excess of boys (57.9% vs. 42.1%). Rate of self-extubation was lower in Midazolam-Fentanyl group; the difference was significant among 3 groups (p < 0.01). There was a significant difference in duration of ventilation in Midazolam- Fentanyl group compared the other groups (Midazolam group and Fentanyl group) (p < 0.001).</span><br /> <strong><em><span>Conclusion</span></em></strong><br /> <span>This study showed that combination therapy with Fentanyl + Midazolam was associated with lower rate of self-extubation and shorter duration of ventilation. In addition, this combination therapy seems safe.</span>