Table 2.
Sedation Profiles of ECMO Patients By Day around Cannulation
| Variables | 3 days earlier (n = 31) | 2 days earlier (n = 35) | 1 day earlier (n = 52) | Day of cannulation (n = 61) | 1 day later (n = 61) | 2 days later (n = 61) | 3 days later (n = 58) |
|---|---|---|---|---|---|---|---|
| Sedatives administered | |||||||
| Opioid dose, median (IQR), mg/kga | 3.2 (1.5–6.5) | 3.5 (1.8–6.8) | 3.7 (1.4–6.2) | 3.7 (2.4–5.6) | 4.9 (2.8–6.9) | 4.6 (2.8–8.1) | 5.2 (3.4–9.8) |
| Number of opioid bolus doses, median (IQR) | 3 (1–6) | 4 (1–6) | 4 (2–6.5) | 4 (2–6) | 4 (1–7) | 4 (2–7) | 6 (1–9) |
| Benzodiazepine dose, median (IQR), mg/kgb | 3.0 (1.3–7.3) | 3.4 (2.0–7.4) | 2.9 (0.9–6.3) | 2.8 (1.2–6.5) | 3.8 (2.2–7.8) | 3.7 (2.2–9.6) | 5.2 (3.4–11.2) |
| Number of benzodiazepine bolus doses, median (IQR) | 3 (1–5) | 3 (1–6) | 3 (1–7) | 2 (1–5) | 3 (1–6) | 3 (1–8) | 4 (1–8) |
| Secondary sedatives, n (%) | |||||||
| Dexmedetomidine | 6 (19) | 7 (20) | 8 (15) | 8 (13) | 11 (18) | 13 (21) | 10 (17) |
| Propofol | 0 | 0 | 0 | 2 (3) | 0 | 1 (2) | 0 |
| Barbiturates | 2 (6) | 1 (3) | 3 (6) | 4 (7) | 5 (8) | 8 (13) | 7 (12) |
| Ketamine | 3 (10) | 2 (6) | 6 (12) | 10 (16) | 3 (5) | 5 (8) | 6 (10) |
| Clonidine | 2 (6) | 3 (9) | 3 (6) | 4 (7) | 3 (5) | 3 (5) | 4 (7) |
| Chloral hydrate | 0 | 0 | 0 | 0 | 1 (2) | 1 (2) | 1 (2) |
| Number of different sedative classes received, median (IQR)c | 2 (2–3) | 2 (2–3) | 2 (2–3) | 2 (2–3) | 2 (2–3) | 2 (2–3) | 2 (2–3) |
| Sedation-related adverse eventsd | |||||||
| Inadequate pain management, n (%) | 0 | 0 | 2 (4) | 0 | 0 | 3 (5) | 1 (2) |
| Inadequate sedation management, n (%) | 0 | 1 (3) | 3 (6) | 0 | 2 (3) | 3 (5) | 2 (3) |
| Sedation scorese | (n = 27) | (n = 35) | (n = 47) | (n = 59) | (n = 56) | (n = 58) | (n = 56) |
| Modal SBS score, n (%) | |||||||
| +1/+2 | 0 | 0 | 1 (2) | 0 | 0 | 2 (3) | 2 (4) |
| −1/0 | 6 (22) | 5 (14) | 4 (9) | 4 (7) | 6 (11) | 6 (10) | 9 (16) |
| −3/−2 | 7 (26) | 12 (34) | 9 (19) | 15 (25) | 20 (36) | 23 (40) | 19 (34) |
| Neuromuscular blockade entire day | 14 (52) | 18 (51) | 33 (70) | 40 (68) | 30 (54) | 27 (47) | 26 (46) |
| Highest SBS score, n (%) | |||||||
| +1/+2 | 3 (11) | 3 (9) | 4 (9) | 4 (7) | 7 (13) | 7 (12) | 10 (18) |
| −1/0 | 8 (30) | 7 (20) | 2 (4) | 3 (5) | 9 (16) | 13 (22) | 10 (18) |
| −3/−2 | 2 (7) | 7 (20) | 8 (17) | 12 (20) | 10 (18) | 11 (19) | 10 (18) |
| Neuromuscular blockade entire day | 14 (52) | 18 (51) | 33 (70) | 40 (68) | 30 (54) | 27 (47) | 26 (46) |
ECMO = extracorporeal membrane oxygenation, IQR = interquartile range, SBS = State Behavioral Scale.
Opioid doses were calculated as morphine equivalents in mg/kg, including morphine (1), fentanyl (0.015), methadone (0.3), enteral codeine (20), hydromorphone (0.15), enteral oxycodone (3), and remifentanil (0.015).
Benzodiazepine doses were calculated as midazolam equivalents in mg/kg, including midazolam (1), clonazepam (0.2), lorazepam (0.3), and diazepam (2).
Different sedatives classes include opioids, benzodiazepines, α2-adrenergic agonists, propofol, barbiturates, ketamine, and chloral hydrate.
Inadequate pain management: pain score >4 [or pain assumed present if receiving neuromuscular blockade] for 2 consecutive hours; inadequate sedation management: SBS score >0 [or agitation assumed present if receiving neuromuscular blockade] for 2 consecutive hours.
The SBS scores range from −3 (unresponsive) to +2 (agitated).