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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References
- Single-center results reporting improved hematopoietic stem cell mobilization success in pediatric and young adult patients with solid tumors and lymphoma.Pediatr Blood Cancer. 2021; 68e29319https://doi.org/10.1002/pbc.29319
- The journey to CAR T cell therapy: the pediatric and young adult experience with relapsed or refractory B-ALL.Blood Cancer J. 2019; 9: 10https://doi.org/10.1038/s41408-018-0164-6
- CAR-T cell therapy: current limitations and potential strategies.Blood Cancer J. 2021; 11: 69https://doi.org/10.1038/s41408-021-00459-7
- Lymphocyte apheresis for chimeric antigen receptor T-cell manufacturing in children and young adults with leukemia and neuroblastoma.Transfusion. 2018; 58: 1414-1420https://doi.org/10.1111/trf.14569
- Predictive factors for successful peripheral blood stem cell mobilization and collection in children.J Clin Apher. 2019; 34: 598-606https://doi.org/10.1002/jca.21738
Stewart S. Autologous Stem Cell Transplants: A Handbook for Patients. BMT Infonet, 2012.
- Optimizing autologous stem cell mobilization strategies to improve patient outcomes: consensus guidelines and recommendations.Biol Blood Marrow Transpl. 2014; 20: 295-308https://doi.org/10.1016/j.bbmt.2013.10.013
- Cell Source and Apheresis.The European Blood and Marrow Transplantation Textbook for Nurses. Springer, 2018: 71-81https://doi.org/10.1007/978-3-319-50026-3_5
- Stem cell mobilization and collection from pediatric patients and healthy children.Transfus Apher Sci. 2015; 2015: 17-22https://doi.org/10.1016/j.transci.2015.05.010
- Dexmedetomidine in children: current knowledge and future applications.Anesth Analog. 2011; 113: 1129-1142https://doi.org/10.1213/ANE.0b013e31822b8629
- Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures.Ther Clin Risk Manag. 2010; 6: 111-121https://doi.org/10.2147/tcrm.s5374
- Dexmedetomidine: the new all-in-one drug in paediatric anesthesia? Current Opinion.Anesthesiology. 2017; 30: 441-451https://doi.org/10.1097/ACO.0000000000000488
- Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine.Clin Pharmacokinet. 2017; 56: 893-913https://doi.org/10.1007/s40262-017-0507-7
- Dexmedetomidine: perioperative applications in children.Paediatr Anesth. 2010; 20: 256-264https://doi.org/10.1111/j.1460-9592.2009.03207.x
- Dexmedetomidine; what’s new for pediatrics? A narrative review.J Clin Med. 2020; 9: 2724https://doi.org/10.3390/jcm9092724
- Dexmedetomidine use in critically ill children with acute respiratory failure.Pediatr Crit Care Med. 2016; 17: 1131-1141https://doi.org/10.1097/PCC.0000000000000941
- The impact of reducing intensive care unit length of stay on hospital costs: evidence from a tertiary care hospital in Canada.Can J Anesth/J Can Anesth. 2018; 65: 627-635https://doi.org/10.1007/s12630-018-1087-1
- Variation in procedural sedation practices among children's hospitals.Hosp Pedia. 2015; 5: 148-153https://doi.org/10.1542/hpeds.2014-0090
- Mobilization and harvesting of peripheral blood stem cells in pediatric patients with solid tumors.Ther Apher Dial. 2011; 15: 579-586https://doi.org/10.1111/j.1744-9987.2011.00990.x
- Procedural sedation in the ICU and emergency department.Curr Opin Anaesthesiol. 2017; 30: 507-512https://doi.org/10.1097/ACO.0000000000000487
- Sedation and analgesia practices in pediatric intensive care units: a survey of 27 centers from turkey.J Pedia Intensive Care. 2020; 10: 289-297https://doi.org/10.1055/s-0040-1716886
- Effects of a PICU status asthmaticus de-escalation pathway on length of stay and albuterol use.Pedia Crit Care Med. 2018; 19: 658-664https://doi.org/10.1097/PCC.0000000000001551
- Reducing avoidable transfer delays in the pediatric intensive care unit for status asthmaticus patients.Pedia Qual Saf. 2022; 7e527https://doi.org/10.1097/pq9.0000000000000527
- Cost analysis of pediatric intensive care: a low-middle income country perspective.BMC Health Serv Res. 2021; 21: 168https://doi.org/10.1186/s12913-021-06166-0
- Hospital costs of pediatric intensive care.Crit Care Med. 1999; 27: 2079-2085https://doi.org/10.1097/00003246-199910000-00001
- Hospitalization rate and costs in acute lymphoblastic leukemia of childhood in a low-income group: financial impact in northeast mexico.Pedia Blood Cancer. 2017; 64e26656https://doi.org/10.1002/pbc.26673
Barrett M.L., Smith M.W., Elixhauser A., Honigman L.S., Pines J.M. Utilization of intensive care services, 2011 HCUP statistical brief #185. Agency for Healthcare Research and Quality 2014. 〈http://www.hcupus.ahrq.gov/reports/statbriefs/sb185-Hospital-Intensive-Care-Units-2011.p〉.
- Dexmedetomidine hydrochloride as a long-term sedative.Ther Clin Risk Manag. 2011; 7: 291-299https://doi.org/10.2147/TCRM.S14581
- Propofol-ketamine versus dexmedetomidine-ketamine for sedation during upper gastrointestinal endoscopy in pediatric patients; a randomized clinical trial.Braz J Anesthesiol. 2020; 70: 620-626https://doi.org/10.1016/j.bjane.2020.09.006
- A prospective randomized controlled trial using propofol or dexmedetomidine for conscious sedation in pediatric patients undergoing sclerotherapy.J Pediatr Neurosci. 2020; 15: 379-385https://doi.org/10.4103/jpn.JPN_167_19
- Association between anesthesia exposure and neurocognitive and neuroimaging outcomes in long-term survivors of childhood acute lymphoblastic leukemia.JAMA Oncol. 2019; 5: 1456-1463https://doi.org/10.1001/jamaoncol.2019.1094
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.
