Abstract
Background
Hematopoietic stem cell (HSC) harvest apheresis and leukapheresis are performed in
the pediatric intensive care unit (PICU) for high-risk pediatric patients who require
procedural sedation. Patients need central access either with their own central lines,
ports or require apheresis catheter (CVL) placement. Previously, patients were either
awake or emerging from sedation on PICU admission. Uncertainty regarding procedural
sedation plans caused delays initiating sedation and apheresis. A guideline was developed
to standardize Dexmedetomidine (DEX) for procedural sedation. We investigated if guideline
implementation would improve efficiency during PICU admission as demonstrated by shorter
time intervals for initiation of sedation, apheresis, PICU length of stay and less
alternative sedating medication.
Methods
Data was collected retrospectively from electronic health records of preguideline
and post-guideline patients who were admitted to the PICU for sedated apheresis. We
compared demographic and clinical characteristics, time intervals for sedation, apheresis,
PICU length of stay, and sedation agents between the two groups using Fisher Exact
tests and Mann-Whitney tests, as appropriate.
Results
The groups did not differ in age or weight at the time of apheresis. All intervals
of time compared were shorter post-guideline. Time intervals from admission to start
of sedation, admission to start of apheresis, and admission to end of apheresis were
statistically significantly different. The type and number of alternative sedating
medications administered did not differ between the two groups.
Conclusion
This guideline implementation improved efficiency during PICU admission. This study
might have been too small to demonstrate statistically significant differences in
other time intervals studied.
Abbreviations:
AC (anticoagulant), ACD-A (anticoagulant citrate dextrose solution, solution A), apheresis (harvest apheresis), BCT (Blood and Cell Technologies), BMT (Bone Marrow Transplant), CAR-T (chimeric antigen receptor T cell), CC (critical care), cMNC (continuous mononuclear cell), CVL (apheresis catheter), DEX (Dexmedetomidine), FLACC (Face, Legs, Activity, Cry, Consolability Behavior Scale), HSC (hematopoietic stem cell), IR (Interventional Radiology), L (Liter), µL (microliters), mL (milliliters), min (minute), MNC (mononuclear cell), PICU (Pediatric Intensive Care Unit), Post (post-guideline), Pre (pre-guideline), PRN (as needed), RASS (Richmond Agitation-Sedation Scale), tPA (tissue plasminogen activator), WBC (white blood cells)Keywords
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Article info
Publication history
Published online: August 19, 2022
Accepted:
August 17,
2022
Received in revised form:
August 2,
2022
Received:
April 5,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd. All rights reserved.