Midazolam exposure in the paediatric intensive care unit predicts acute post-traumatic stress symptoms in children |
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| Affiliation: | 1. Paediatric Intensive Care Unit, Queensland Children''s Hospital, Brisbane, Australia;2. School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia;3. Child Health Research Centre, The University of Queensland, Brisbane, Australia;4. School of Psychology, The University of Queensland, Brisbane, Australia;5. School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia;6. Menzies Health Institute, Griffith University, Brisbane, Australia;7. Metro North Hospital and Health Service, Brisbane, Australia;1. Frankston Hospital, Frankston, VIC Australia;2. The Bays Hospital, Mornington, VIC Australia;3. Monash University, Frankston, VIC Australia;4. Werribee Mercy Hospital, Werribee, VIC, Australia;5. Austin Health VIC, Heidelburg, Australia;6. Griffith University, University of Queensland, Qld Australia;7. Flinders University and Flinders Medical Center, SA, Australia;8. Aster CMI Hospital, Bangalore, India;9. Western Health, VIC, Australia;10. National University Hospital, Singapore;11. Yong Loo Lin School of Medicine, National University of Singapore, Singapore;12. University of Sydney, Nepean Clinical School and Nepean Hospital, Kingswood, NSW, Australia;13. Anaesthesia and Intensive Care Unit, Imperial College London, London, UK;14. Anesthesia and Intensive Care Unit, Sundsvall Hospital, Sundsvall, Sweden;15. Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland;p. University of Queensland, Brisbane, Qld, Australia;q. Bond University, Gold Coast, Qld, Australia;r. Calvary Public Hospital, ACT, Canberra, Australia;s. Casey Monash Hospital, Berwick, VIC, Australia;1. Department of Nursing, Physiotherapy and Medicine, Universidad de Almería, Spain;2. Research Group for Health Center CTS-451, Health Research Center, Universidad de Almería, Spain;1. Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia;2. Wellcome-Wolfson Institute for Experimental Medicine, Queen''s University Belfast, United Kingdom;3. Lane Fox Clinical Respiratory Physiology Research Centre, Guy''s and St. Thomas'' NHS Foundation Trust, London, United Kingdom;4. Centre for Human and Applied Physiological Sciences, King''s College London, United Kingdom;5. Department of Physiotherapy, The University of Melbourne, Melbourne, Australia;1. Austin Health, Melbourne, Australia;2. Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia;3. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;4. Western Health, Melbourne, Australia;5. The Alfred Hospital, Melbourne, Australia;6. School of Public Health & Preventative Medicine, Monash University, Australia;7. Faculty of Engineering & Information Technologies, The University of Sydney, Australia;8. Monash Partners Academic Health Science Centre, Australia;9. Epworth Hospital, Melbourne, Australia;10. Deakin University, Melbourne, Geelong, Australia;11. Health Data Research UK, Swansea University Medical School, Swansea University, UK;12. University of Michigan, Michigan, USA;13. Monash Medical Centre, Melbourne, Australia;14. School of Psychological Sciences, Monash University, Melbourne, Australia;15. Department of Medicine and Radiology, University of Melbourne, Melbourne, Australia;1. Deakin University, School of Nursing and Midwifery & Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria, 3220, Australia;2. Deakin University, Centre for Quality and Patient Safety Research 1 Gheringhap St, Geelong, Victoria, 3220, Australia;3. Deakin University, Deakin Learning Futures, Office of the Deputy Vice Chancellor (Education), 1 Gheringhap St, Geelong, Victoria, 3220, Australia;4. Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia;5. School of Public Health and Preventive Medicine, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia;6. Department of Surgery, University of Melbourne, Parkville, Victoria, 3010, Australia |
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| Abstract: | BackgroundClinically significant post-traumatic stress symptoms (PTSS) have been reported in up to a quarter of paediatric intensive care unit (PICU) survivors. Ongoing PTSS negatively impacts children's psychological development and physical recovery. However, few data regarding associations between potentially modifiable PICU treatment factors, such as analgosedatives and invasive procedures, and children's PTSS have been reported.ObjectivesWe sought to investigate the medical treatment factors associated with children's PTSS after PICU discharge.MethodsA prospective longitudinal cohort study was conducted in two Australian tertiary referral PICUs. Children aged 2-16 y admitted to the PICU between June 2008 and January 2011 for >8 h and <28 d were eligible for participation. Biometric and clinical data were obtained from medical records. Parents reported their child's PTSS using the Trauma Symptom Checklist for Young Children at 1, 3, 6, and 12 months after discharge. Logistic regression was used to assess potential associations between medical treatment and PTSS.ResultsA total of 265 children and their parents participated in the study. In the 12-month period following PICU discharge, 24% of children exhibited clinically elevated PTSS. Median risk of death (Paediatric Index of Mortality 2 [PIM2]) score was significantly higher in the PTSS group (0.31 [IQR 0.14–1.09] v 0.67 [IQR 0.20–1.18]; p = 0.014). Intubation and PICU and hospital length of stay were also significantly associated with PTSS at 1 month, as were midazolam, propofol, and morphine. After controlling for gender, reason for admission, and PIM2 score, only midazolam was significantly and independently associated with PTSS and only at 1 month (adjusted odds ration (aOR) 3.63, 95% CI 1.18, 11.12, p = 0.024). No significant relationship was observed between the use of medications and PTSS after 1 month.ConclusionsElevated PTSS were evident in one quarter (24%) of children during the 12 months after PICU discharge. One month after discharge, elevated PTSS were most likely to occur in children who had received midazolam therapy. |
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| Keywords: | Stress disorders Post-traumatic Psychological trauma Intensive care units Paediatric Hypnotics and sedatives |
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