clinical practice
“ Identification of the early distress allows medical professionals to engage families sooner .
Cause and effect
QUT study links sedative use in children with post traumatic stress .
By Wade Zaglas
A
drug commonly used to sedate children receiving treatment in intensive care has been identified as a “ possible predictor ” of post traumatic stress symptoms ( PTSS ), a study led by the Queensland University of Technology ( QUT ) has found .
The study , which has been published in Australian Critical Care and holds significant implications for at-risk children , found that 24 per cent of children who were treated with midazolam showed elevated PTSS symptoms during the 12 months following hospital discharge .
Midazolam is a benzodiazepine used to sedate children when life saving treatments like intubation are required , but the long-term side effects of using the drug in children have not been explored previously .
THE STUDY The first longitudinal study on the effects on children receiving midazolam was a collaboration between QUT , UQ and Children ’ s Health Queensland . Co-led by associate professor Debbie Long from QUT , the study was conducted between 2008 and 2011 and included 265 children from two Queensland hospitals . The children were aged 2-16 years , and parents completed surveys related to their child ’ s behaviour at intervals of one , three , six and 12 months .
Long said the study concluded that the children were almost four times more likely to be displaying “ elevated post traumatic stress symptoms after intensive care ” if they were exposed to midazolam . While the QUT professor said drug protocols for children admitted to intensive care have changed recently as safer options have become available , midazolam was still widely used .
The study was therefore critical in raising awareness of the drug ’ s “ potential adverse effects and the need for early intervention ”, particularly among at-risk children .
During the study the team of researchers demonstrated that another drug , dexmedetomidine , could be used for up to 14 days for sedation and did not have the amnesiac effects of midazolam . However , Long stated that midazolam could not be completely replaced .
“ One of the benefits of dexmedetomidine is that we can reach the desired levels of sedation quickly and safely and have more awake sedation , allowing children to be calm and comfortable ,” Long said .
“ But there are some illnesses and injuries , such as seizures , for which midazolam is still considered the first line therapy so it is unlikely that the drug will be completely removed from our treatment armoury .”
Each year more than 10,000 children are treated in intensive care units in Australia and New Zealand because of trauma , critical illness or requiring life support . The bulk of children admitted to intensive care are under five years of age , Long states , with roughly 50 per of those under the age of two .
“ It was thought that giving a child midazolam would help them forget being in intensive care . But unfortunately , we think it distorts their memory making process ,” she said .
“ It ’ s possible they construct nonfactual memories and that , combined with drug withdrawal-related delirium , could lead to post traumatic stress in the acute recovery phase .
“ We ’ re starting to wonder if early post traumatic stress is a gateway disorder to anxiety and depression even if it resolves , because health conditions like these are doubling as more children survive intensive care .
“ If symptoms are not identified and managed early , the ripple effect could be life-long – affecting relationships at home , school or when getting a job in later years .”
The QUT professor said the symptoms were significant in the first month after treatment involving midazolam , but could continue for 10-12 months before resolving , and that some children still had elevated symptoms at 12 months .
“ Our concern is that families with children who experience post traumatic stress won ’ t engage in ongoing care because they ’ re too traumatised ,” she said .
“ Identification of the early distress allows medical professionals to engage families sooner and monitor children more closely .”
While this study explored the association between post traumatic stress symptoms in children and intensive care treatment , Long said “ non-treatment factors ” such as distressed parents during the child ’ s admission phase , and “ pre-existing internalising child behaviours also predicted ongoing distress after hospital discharge ”.
Building on this study , Long will colead an interventional study to investigate psychosocial support for both children and parents , and “ ways to normalise the hospital treatment process to reduce the incidence of post traumatic stress ”. ■
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