Rate of Self-Extubation in Pediatric Intensive Care Unit Following Administration of Fentanyl, Midazolam and Midazolam-Fentanyl Combination: A Comparative Study

Background Self-extubation is a problem in pediatric intensive care unit (PICU) and can be harmful for children. Level of sedation is a determining factor for self-extubation. The aim of this study was to compare thr rate of self-extubation and duration of ventilation following different sedative modalities. Materials and Methods This prospective and randomized study was done in Mofid Children Hospital, Tehran, Iran from October 2015 to September 2016. One hundred and fifty seven children from 1 month to 15 years of age with normal consciousness level requiring mechanical ventilation were included.The rate of self-extubation, and duration of ventilation were compared among 3 groups; Midazolam group (n= 50) 0.1 mg/kg/hr, Fentanyl group (n= 50) 2 mcg/kg/hr., and Midazolam-Fentanyl group (n= 57); midazolam 0.05 mg/kg/hr and fentanyl 1 mcg/kg/hr. All administrations were IV. Optimal level of sedation was 2-3 using Ramsay score. Results: One hundred and fifty seven children were studied. The mean age of patients was 4.5 ± 1.5 years with an excess of boys (57.9% vs. 42.1%). Rate of self-extubation was lower in Midazolam-Fentanyl group; the difference was significant among 3 groups (p < 0.01). There was a significant difference in duration of ventilation in Midazolam- Fentanyl group compared the other groups (Midazolam group and Fentanyl group) (p < 0.001). Conclusion This study showed that combination therapy with Fentanyl + Midazolam was associated with lower rate of self-extubation and shorter duration of ventilation. In addition, this combination therapy seems safe.