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Atropine for critical care intubation in a cohort of 264 children and reduced mortality unrelated to effects on bradycardia.

Jones P, Peters MJ, Pinto da Costa N, Kurth T, Alberti C, Kessous K, Lode N, Dauger S - PLoS ONE (2013)

Bottom Line: The unadjusted ICU mortality was 7.2% (9/124) for those who received atropine compared to 15.7% (22/140) for those who did not (OR 0.42, 95%CI 0.19-0.95, p=0.04).Atropine use during induction was associated with a reduction in ICU mortality in children over one month.This result needs to be confirmed in a study using randomised methodology.

View Article: PubMed Central - PubMed

Affiliation: Critical Care Group - Portex Unit, Institute of Child Health, University College London, London, Great Britain.

ABSTRACT

Background: Atropine has is currently recommended to facilitate haemodynamic stability during critical care intubation. Our objective was to determine whether atropine use at induction influences ICU mortality.

Methodology/principal findings: A 2-year prospective, observational study of all first non-planned intubations, September 2007-9 in PICU and Intensive Care Transport team of Hôpital Robert Debré, Paris, 4 other PICUs and 5 NICUs in the Paris Region, France. Follow-up was from intubation to ICU discharge. A propensity score was used to adjust for patient specific characteristics influencing atropine prescription. 264/333 (79%) intubations were included. The unadjusted ICU mortality was 7.2% (9/124) for those who received atropine compared to 15.7% (22/140) for those who did not (OR 0.42, 95%CI 0.19-0.95, p=0.04). One child died during intubation (1/264, 0.4%). Two age sub-groups of neonates (≤28 days) and older children (>28 days, <8 years) were examined. This difference in mortality arose from the higher mortality in children aged over one month when atropine was not used (propensity score adjusted OR 0.22, 95%CI 0.06-0.85, p=0.028). No effect was seen in neonates (propensity score adjusted OR 1.3, 95%CI 0.31-5.1 p=0.74). Using the propensity score, atropine maintained the mean heart rate 45.9 bpm above that observed when no atropine was used in neonates (95%CI 34.3-57.5, p<0.001) and 43.5 bpm for older children (95%CI 25.5-61.5 bpm, p<0.001).

Conclusions/significance: Atropine use during induction was associated with a reduction in ICU mortality in children over one month. This effect is independent of atropine's capacity to attenuate bradycardia during intubation which occurred similarly in neonates and older children. This result needs to be confirmed in a study using randomised methodology.

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Related in: MedlinePlus

Flow-chart of inclusions, non-inclusions and exclusions. Neonates are ≤28 days and older children >28 days and less than 8 years.*ICT - Intensive Care Transport team positioned antenatally for premature births.
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pone-0057478-g001: Flow-chart of inclusions, non-inclusions and exclusions. Neonates are ≤28 days and older children >28 days and less than 8 years.*ICT - Intensive Care Transport team positioned antenatally for premature births.

Mentions: A total of 333 children were eligible for inclusion of which 277 were included. Fifty-six children were not included and 13 children were excluded (Figure 1). A total of 264 study patients were available for analysis (264/333, 79% [95%CI 75–83]) of which 114 from PICU and 150 from ICT. Twenty-three intensivists included a median of 5 [1]–[16] children each. Atropine was prescribed in 124 of the 264 (47% [95%CI 41–53]) intubations. It was more frequently prescribed, although not significantly (p = 0.08), during the intubations of neonates (79/153, 52% [95%CI 44–59]) than older children (45/111, 41% [95%CI 32–50]) (Table 1 and Figure 1). The median frequency of atropine prescription per intensivist was 2 [1]–[8]. The PRISM score was retrospectively available for 94 of 111 older children and was not significantly (p = 0.09) different between the atropine and non-atropine groups (Table 1).


Atropine for critical care intubation in a cohort of 264 children and reduced mortality unrelated to effects on bradycardia.

Jones P, Peters MJ, Pinto da Costa N, Kurth T, Alberti C, Kessous K, Lode N, Dauger S - PLoS ONE (2013)

Flow-chart of inclusions, non-inclusions and exclusions. Neonates are ≤28 days and older children >28 days and less than 8 years.*ICT - Intensive Care Transport team positioned antenatally for premature births.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585379&req=5

pone-0057478-g001: Flow-chart of inclusions, non-inclusions and exclusions. Neonates are ≤28 days and older children >28 days and less than 8 years.*ICT - Intensive Care Transport team positioned antenatally for premature births.
Mentions: A total of 333 children were eligible for inclusion of which 277 were included. Fifty-six children were not included and 13 children were excluded (Figure 1). A total of 264 study patients were available for analysis (264/333, 79% [95%CI 75–83]) of which 114 from PICU and 150 from ICT. Twenty-three intensivists included a median of 5 [1]–[16] children each. Atropine was prescribed in 124 of the 264 (47% [95%CI 41–53]) intubations. It was more frequently prescribed, although not significantly (p = 0.08), during the intubations of neonates (79/153, 52% [95%CI 44–59]) than older children (45/111, 41% [95%CI 32–50]) (Table 1 and Figure 1). The median frequency of atropine prescription per intensivist was 2 [1]–[8]. The PRISM score was retrospectively available for 94 of 111 older children and was not significantly (p = 0.09) different between the atropine and non-atropine groups (Table 1).

Bottom Line: The unadjusted ICU mortality was 7.2% (9/124) for those who received atropine compared to 15.7% (22/140) for those who did not (OR 0.42, 95%CI 0.19-0.95, p=0.04).Atropine use during induction was associated with a reduction in ICU mortality in children over one month.This result needs to be confirmed in a study using randomised methodology.

View Article: PubMed Central - PubMed

Affiliation: Critical Care Group - Portex Unit, Institute of Child Health, University College London, London, Great Britain.

ABSTRACT

Background: Atropine has is currently recommended to facilitate haemodynamic stability during critical care intubation. Our objective was to determine whether atropine use at induction influences ICU mortality.

Methodology/principal findings: A 2-year prospective, observational study of all first non-planned intubations, September 2007-9 in PICU and Intensive Care Transport team of Hôpital Robert Debré, Paris, 4 other PICUs and 5 NICUs in the Paris Region, France. Follow-up was from intubation to ICU discharge. A propensity score was used to adjust for patient specific characteristics influencing atropine prescription. 264/333 (79%) intubations were included. The unadjusted ICU mortality was 7.2% (9/124) for those who received atropine compared to 15.7% (22/140) for those who did not (OR 0.42, 95%CI 0.19-0.95, p=0.04). One child died during intubation (1/264, 0.4%). Two age sub-groups of neonates (≤28 days) and older children (>28 days, <8 years) were examined. This difference in mortality arose from the higher mortality in children aged over one month when atropine was not used (propensity score adjusted OR 0.22, 95%CI 0.06-0.85, p=0.028). No effect was seen in neonates (propensity score adjusted OR 1.3, 95%CI 0.31-5.1 p=0.74). Using the propensity score, atropine maintained the mean heart rate 45.9 bpm above that observed when no atropine was used in neonates (95%CI 34.3-57.5, p<0.001) and 43.5 bpm for older children (95%CI 25.5-61.5 bpm, p<0.001).

Conclusions/significance: Atropine use during induction was associated with a reduction in ICU mortality in children over one month. This effect is independent of atropine's capacity to attenuate bradycardia during intubation which occurred similarly in neonates and older children. This result needs to be confirmed in a study using randomised methodology.

Show MeSH
Related in: MedlinePlus