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279: TRENDS IN NEUROPHARMACOLOGIC AGENT USE IN MECHANICALLY VENTILATED YOUNG CARDIAC SURGERY PATIENTS

Learning Objectives: Children who undergo cardiac surgery and require mechanical ventilation (MV) in the ICU often receive neuropharmacologic agents like opiates and sedatives, though the US FDA warns that some agents may have neurotoxic effects. We aimed to identify temporal trends in the use of neuropharmalogic agents in this cohort. Methods: With IRB approval, ICU patients <3yo discharged from one of 45 hospitals participating in the Pediatric Health Information System (PHIS) database between January 2006 and September 2015 who 1) received MV for ≥2 days and 2) underwent cardiac surgery were identified. Demographics, outcomes, neuropharmalogic agents prescribed for ≥2 days and usage of services that diagnose/treat neurologic injury (e.g. physical therapy, swallow study, brain MRI) were extracted. Change in usage over time was defined as p<0.05 with simple linear regression. Results: Among 36,558 patients, 56% were male, median age was 25 (IQR: 1–138) days. Significant increases were observed in prescription of ≥5 different drugs/drug classes (29.8% [2006] to 44.4% [2015]) and usage of ≥2 services (29.6% to 54.5%). Specific agents used increasingly included dexmedetomidine (5.1% to 46.0%), ketamine (9.7% to 21.0%) and clonidine (1.1% to 11.5%). ECMO use increased (5.1% to 9.3%) but mortality did not. Conclusions: We identified significant increases in the overall use of neuropharmalogic medications as well as individual agents in mechanically ventilated pediatric patients undergoing cardiac surgery. There has been a concurrent increase in services that diagnose/treat neurologic morbidity.