1254: Chloral Hydrate as Supplemental Picu Sedation to Reduce Opioid and Benzodiazepine Requirements

Introduction: Opioids and benzodiazepines are medications commonly used in the PICU for sedation. However, higher cumulative doses and prolonged exposure are associated with complications such as delirium and Iatrogenic Withdrawal. Chloral hydrate (CH) is an enteral sedative agent often prescribed for outpatient sedation. Its outpatient use has decreased considerably due to concerns for oversedation in unmonitored environment. In a PICU setting use of CH for sedation is less well described. Our objective was to determine if administration of CH is associated with changes in opioid and benzodiazepine requirements or withdrawal and delirium scores. Methods: Our retrospective cohort study identified children admitted to the PICU from 03/2019 to 12/2023 who received CH. We identified mean opioid dose in morphine equivalents (ME), mean benzodiazepine equivalents (BE) day prior (day-1) to and on first day of CH (day 0). We also assessed daily Withdrawal Assessment Tool (WAT-1) and Cornell Assessment of Pediatric Delirium (CAPD) scores before, during and after receiving CH during admission (durations capped to 7 days for each). Sedation doses were compared with paired t-test and CAPD and WAT scores by KW test. Results: A total of 109 patients received CH during the study period. The mean ME dose on day -1 of administration of CH was 2.35 mg/kg vs. 2.07 mg/kg on the day of CH receipt with a mean difference of -0.3 (95% CI -0.91, 0.29). There was no meaningful decrease in BE (mean BE 0.65 mg/kg on Day -1, vs 0.64 mg/kg on day 0). There were 65 patients with recorded CAPD and 102 patients with WAT-1 scores who received CH within capped durations. CH was more likely to be used when patients were having higher CAPD scores (median score of 8 IQR 4,11) vs prior 7 days (median 6 IQR 3, 8 and post 7 days (median 5 IQR 2, 9), p 0.002. Similarly, CH was more often prescribed when patients were exhibiting signs of withdrawal (Median WAT score during treatment of 4 IQR 2, 5), prior 7 days of 2 IQR 1, 4 and post therapy of 2 IQR 1, 3, p< 0.001) Conclusions: Despite its more frequent use during periods of withdrawal and delirium, CH can lead to less use of opioids in PICU. Its causal association with withdrawal and delirium need to be evaluated in prospective studies.