A RANDOMIZED CONTROLLED TRIAL OF SEDATION IN THE CRITICALLY ILL

A randomized controlled trial comparing: a) a combination of oral chlo ral hydrate and promethazine to b) a continuous intravenous midazolam infusion, for maintenance sedation in critically ill children, was car ried out. The level of sedation was assessed four hourly using a speci fically devized sedation scale. Forty-four children entered the study of whom two were subsequently excluded. The number of satisfactory ass essments (desired and actual levels of sedation equal) was significant ly greater in the chloral hydrate and promethazine group (Chi-squared P<0.01; confidence intervals of the difference 0.06 to 0.20). The numb er of assessments at level 5 on the sedation scale (patient restless/d istressed) was significantly greater in the midazolam group (Chi-squar ed P<0.05). The total number of satisfactory assessments in the two gr oups were only 61 and 48% respectively, suggesting that sedation can b e considerably improved. Chloral hydrate and promethazine are more eff ective than midazolam as maintenance sedation in critically ill childr en. It is possible to prospectively study the efficacy of sedative dru gs in critically ill children.