Introduction:

Children admitted to the pediatric intensive care unit (PICU) following liver transplantation frequently require analgesia and sedation in the immediate postoperative period. We used the Pediatric Health Information System (PHIS) database to assess trends and variations in sedation and analgesia used in this cohort.

Method:

Multicenter retrospective cohort study using PHIS data from 2012-2022.

Results:

During the study period, evaluated 3,963 pediatric patients from 32 US children’s hospitals who received a liver transplantation and were admitted to the PICU post operatively, with mean age of 5.16 years [5.74]. 54% of patients received mechanical ventilation (MV) post operatively. There were statistically significant differences between patients receiving MV vs. non-MV in terms of IV medication use -- morphine (57% vs 49%, p<0.001), fentanyl (57% vs 44%, p<0.001), midazolam (45% vs 31%, p<0.001), lorazepam (39% vs. 24%, p<0.001), propofol (30% vs 26%, p<0.001), dexmedetomidine (38% vs 30%, p<0.001), and ketamine (25% vs 12%, p<0.001). There was also a significant difference in vasopressor use (35% vs. 22%, p<0.001). There was an increasing trend in use of intravenous acetaminophen, dexmedetomidine and ketamine, while use of benzodiazepines decreased (p<0.001).

Conclusion:

About 50% of liver transplant patients still receive MV in the PICU postoperatively and subsequently receive more benzodiazepines compared to non-MV. However, there is an increasing trend in dexmedetomidine, intravenous acetaminophen and ketamine usage during the study period with a decreasing trend in use of benzodiazepines.