Abstract：
To describe the doses of opioids and benzodiazepines administered around the time of terminal extubation (TE) to children who died within 1 hour of TE and to identify their association with the time to death (TTD).
Secondary analysis of data collected for the Death One Hour After Terminal Extubation study.
Nine U.S. hospitals.
Six hundred eighty patients between 0 and 21 years who died within 1 hour after TE (2010-2021).
Medications included total doses of opioids and benzodiazepines 24 hours before and 1 hour after TE. Correlations between drug doses and TTD in minutes were calculated, and multivariable linear regression performed to determine their association with TTD after adjusting for age, sex, last recorded oxygen saturation/F io2 ratio and Glasgow Coma Scale score, inotrope requirement in the last 24 hours, and use of muscle relaxants within 1 hour of TE. Median age of the study population was 2.1 years (interquartile range [IQR], 0.4-11.0 yr). The median TTD was 15 minutes (IQR, 8-23 min). Forty percent patients (278/680) received either opioids or benzodiazepines within 1 hour after TE, with the largest proportion receiving opioids only (23%, 159/680). Among patients who received medications, the median IV morphine equivalent within 1 hour after TE was 0.75 mg/kg/hr (IQR, 0.3-1.8 mg/kg/hr) ( n = 263), and median lorazepam equivalent was 0.22 mg/kg/hr (IQR, 0.11-0.44 mg/kg/hr) ( n = 118). The median morphine equivalent and lorazepam equivalent rates after TE were 7.5-fold and 22-fold greater than the median pre-extubation rates, respectively. No significant direct correlation was observed between either opioid or benzodiazepine doses before or after TE and TTD. After adjusting for confounding variables, regression analysis also failed to show any association between drug dose and TTD.
Children after TE are often prescribed opioids and benzodiazepines. For patients dying within 1 hour of TE, TTD is not associated with the dose of medication administered as part of comfort care.
Secondary analysis of data collected for the Death One Hour After Terminal Extubation study.
Nine U.S. hospitals.
Six hundred eighty patients between 0 and 21 years who died within 1 hour after TE (2010-2021).
Medications included total doses of opioids and benzodiazepines 24 hours before and 1 hour after TE. Correlations between drug doses and TTD in minutes were calculated, and multivariable linear regression performed to determine their association with TTD after adjusting for age, sex, last recorded oxygen saturation/F io2 ratio and Glasgow Coma Scale score, inotrope requirement in the last 24 hours, and use of muscle relaxants within 1 hour of TE. Median age of the study population was 2.1 years (interquartile range [IQR], 0.4-11.0 yr). The median TTD was 15 minutes (IQR, 8-23 min). Forty percent patients (278/680) received either opioids or benzodiazepines within 1 hour after TE, with the largest proportion receiving opioids only (23%, 159/680). Among patients who received medications, the median IV morphine equivalent within 1 hour after TE was 0.75 mg/kg/hr (IQR, 0.3-1.8 mg/kg/hr) ( n = 263), and median lorazepam equivalent was 0.22 mg/kg/hr (IQR, 0.11-0.44 mg/kg/hr) ( n = 118). The median morphine equivalent and lorazepam equivalent rates after TE were 7.5-fold and 22-fold greater than the median pre-extubation rates, respectively. No significant direct correlation was observed between either opioid or benzodiazepine doses before or after TE and TTD. After adjusting for confounding variables, regression analysis also failed to show any association between drug dose and TTD.
Children after TE are often prescribed opioids and benzodiazepines. For patients dying within 1 hour of TE, TTD is not associated with the dose of medication administered as part of comfort care.
摘要：
目的：描述在术后1小时内死亡的儿童在终末期拔管（TE）前后使用阿片类药物和苯二氮卓类药物的剂量，并确定其与死亡时间（TTD）的关系。
方法：对终末拔管后一小时死亡研究收集的数据进行二次分析。
方法：美国九家医院。
方法：在TE后1小时内死亡的180名0至21岁患者（2010-2021年）。
结果：药物包括在TE之前24小时和之后1小时的阿片类药物和苯二氮卓类药物的总剂量。以分钟计算药物剂量与TTD之间的相关性，和多元线性回归进行调整后，以确定它们与TTD的关联，性别,最后记录的氧饱和度/Fio2比值和格拉斯哥昏迷评分，在过去24小时内对Inotrope的要求，并在TE后1小时内使用肌肉松弛剂。研究人群的中位年龄为2.1岁(四分位间距[IQR]，0.4-11.0年）。TTD中位数为15分钟(IQR，8-23分钟）。40%的患者（278/680）在TE后1小时内接受了阿片类药物或苯二氮卓类药物，仅接受阿片类药物的比例最大(23%，159/680）。在接受药物治疗的患者中，TE后1小时内静脉注射吗啡当量中位数为0.75mg/kg/hr(IQR，0.3-1.8mg/kg/hr）（n=263），和中位数劳拉西泮当量为0.22mg/kg/hr（IQR，0.11-0.44mg/kg/hr)(n=118)。TE后的中位吗啡当量和劳拉西泮当量比中位拔管前比率高7.5倍和22倍，分别。在TE和TTD之前或之后，阿片类药物或苯二氮卓剂量之间均未观察到显着的直接相关性。调整混杂变量后，回归分析也未能显示药物剂量与TTD之间的任何关联.
结论：TE后的儿童通常使用阿片类药物和苯二氮卓类药物。对于在TE后1小时内死亡的患者，TTD与作为舒适护理的一部分施用的药物剂量无关。
方法：对终末拔管后一小时死亡研究收集的数据进行二次分析。
方法：美国九家医院。
方法：在TE后1小时内死亡的180名0至21岁患者（2010-2021年）。
结果：药物包括在TE之前24小时和之后1小时的阿片类药物和苯二氮卓类药物的总剂量。以分钟计算药物剂量与TTD之间的相关性，和多元线性回归进行调整后，以确定它们与TTD的关联，性别,最后记录的氧饱和度/Fio2比值和格拉斯哥昏迷评分，在过去24小时内对Inotrope的要求，并在TE后1小时内使用肌肉松弛剂。研究人群的中位年龄为2.1岁(四分位间距[IQR]，0.4-11.0年）。TTD中位数为15分钟(IQR，8-23分钟）。40%的患者（278/680）在TE后1小时内接受了阿片类药物或苯二氮卓类药物，仅接受阿片类药物的比例最大(23%，159/680）。在接受药物治疗的患者中，TE后1小时内静脉注射吗啡当量中位数为0.75mg/kg/hr(IQR，0.3-1.8mg/kg/hr）（n=263），和中位数劳拉西泮当量为0.22mg/kg/hr（IQR，0.11-0.44mg/kg/hr)(n=118)。TE后的中位吗啡当量和劳拉西泮当量比中位拔管前比率高7.5倍和22倍，分别。在TE和TTD之前或之后，阿片类药物或苯二氮卓剂量之间均未观察到显着的直接相关性。调整混杂变量后，回归分析也未能显示药物剂量与TTD之间的任何关联.
结论：TE后的儿童通常使用阿片类药物和苯二氮卓类药物。对于在TE后1小时内死亡的患者，TTD与作为舒适护理的一部分施用的药物剂量无关。
