Longitudinal Trends in Sedation and Analgesia in Mechanically Ventilated Children With Bronchiolitis

Introduction: Critical bronchiolitis is a leading cause of pediatric hospitalization and a major driver of resource utilization in pediatric intensive care units. Sedation and analgesia are essential for ensuring patient comfort and ventilator synchrony in children receiving invasive mechanical ventilation (IMV); however, sedoanalgesic usage in this population is not well characterized. We describe the exposure to continuous sedoanalgesic infusions during the first five days of IMV in critical bronchiolitis and hypothesized usage patterns would change over time


Methods: We conducted a retrospective analysis using automated extraction of electronic health records from Duke University Hospital for admissions between January 1, 2013, and December 31, 2023. Patients were included if they were ≤24 months old and required IMV for bronchiolitis. Exclusion criteria included congenital heart disease, tracheostomy, postoperative status, neurologic etiology for respiratory failure, dialysis, or extracorporeal membrane oxygenation. We collected demographic data, comorbidities, viral test results, clinical outcomes, scoring tools, and medication administration records. Categorical and continuous variables were summarized using counts (%) and medians (IQR).


Results: We identified 100 eligible patient encounters with a median age of 6.8 months (IQR 2.2–12.9). Comorbidities included prematurity (51%), pneumonia (28%), and sepsis (14%). A median of 3 (IQR 2–3) simultaneous infusions were administered during IMV. Opioids were most commonly used (94%). Median doses while ventilated were: IV morphine 0.31 mg/kg/hr (IQR 0.24–0.41), IV dexmedetomidine 0.5 mcg/kg/hr (IQR 0.19–0.95), and IV midazolam 0.07 mg/kg/hr (IQR 0.03–0.13). We observed a decrease in dexmedetomidine use after day 2 of IMV, whereas benzodiazepine use increased over time. Continuous neuromuscular blockade was used in 43% of patients.


Conclusions: Children with critical bronchiolitis exhibit high exposures to continuous sedoanalgesic infusions and frequent use of neuromuscular blockade. These findings underscore the need for further investigation into sedation strategies and their implications in this population. Our dataset may support future studies aimed at optimizing sedation practices in pediatric bronchiolitis.