ABSTRACT
BACKGROUND: The aim of this study was to prospectively evaluate and report the experience of the use of continuous intravenous propofol sedation in a paediatric intensive care unit (PICU). METHODS: All children younger than 16 years who were admitted to the PICU at a University Hospital for slightly more than a year and received propofol infusion were included prospectively and data were recorded before and within 6 h after completion of the propofol infusion. RESULTS: A total of 174 out of 955 children (18·2%) received propofol infusion for sedation. The median age was 2 years 10 months (range: 2 months to 16 years), duration of propofol infusion 13 h (range: 1·6-179 h) and dose of propofol 2·9 mg/kg/h (range: 0·3-6·5 mg/kg/h). No one developed signs of the propofol infusion syndrome (PRIS). Neither dose >3 mg/kg/h, duration of infusion >48 h nor both were found to be related to adverse metabolic derangements or circulatory failure. Eight children increased their lactate concentration ≥1·8 mmol/L during propofol infusion. All had a favourable outcome. One child who had received propofol infusion for 10 h died, but this occurred 14 h after the infusion ceased and was without doubt attributed to a multiple organ failure not related to the propofol infusion. CONCLUSION: Propofol infusion was used in this population at low risk of PRIS with no metabolic or circulatory adverse effects. These findings indicate that the occurrence of adverse effects may not be directly related to dose or duration of infusion, but emphasizes the risk that sporadic factors may be involved, such as genetic mutations. Guidelines are presented.
Subject(s)
Critical Care/methods , Hypnotics and Sedatives/therapeutic use , Pediatrics/methods , Propofol/therapeutic use , Adolescent , Child , Child, Preschool , Female , Humans , Hypnotics and Sedatives/administration & dosage , Hypnotics and Sedatives/adverse effects , Infant , Infusions, Intravenous , Intensive Care Units, Pediatric , Male , Practice Guidelines as Topic , Propofol/administration & dosage , Propofol/adverse effects , Prospective Studies , Treatment OutcomeABSTRACT
It is important that pediatric nurses know that the methods they use are reliable and the most appropriate for the child's security and well being. In-out catheterization is a sterile invasive method to obtain a urine sample in young children. To confirm this as a reliable method, a study of medical records from 61 children ages 0 to 24 months with suspected urinary tract infections (UTIs) was performed. Each child had produced both a urine sample from an adhesive bag and a urine sample from in-out catheterization. Dipsticks were taken from both samples; and the methods were compared with kappa analysis. Cultures were obtained from the catheter urine. UTI was verified as a growth in the catheter urine in 32 out of 61 children. Catheterized samples of urine with 3+ or 4+ of leucocytes all had a growth of bacteria in the culture. This examination of medical records showed that in-out catheterization is a reliable method to use to confirm UTIs in children 0 to 24 months.
