Edward J Cullen

Plasma Concentrations Following Application of Whole versus Cut Transdermal Clonidine Patches To Critically Ill Children

Clonidine is used for hypertension and narcotic withdrawal prophylaxis in adults and children. This study described plasma absorption of clonidine from whole and cut transdermal clonidine patches. This was a retrospective descriptive study in an 18 bed multidisciplinary pediatric intensive care unit, evaluating 15 critically ill children with a median age of 1.1 years (range 0.3-11 years) treated with transdermal clonidine for narcotic withdrawal prophylaxis, and who had plasma clonidine concentrations measured. An assessment of the relationship between clonidine dose and patch integrity (whole vs. cut) with plasma concentrations was performed, with further analysis by Spearman Correlation Coefficient. Clonidine doses averaged 7.5±4.2 μg/kg/day (range 2.3-20 μg/kg/day) for 9.8±4.3 days (range 4-20 days). There were 9 cut patches and 6 whole patches. The average prescribed dose delivered by cut patches was 6.4±3 μg/kg/day, resulting in a mean plasma concentration of 1±1.1 ng/ mL (range <0.05-3.3 ng/mL). The average prescribed dose delivered by whole patches was 7±1.7 μg/kg/day, resulting in a mean plasma concentration of 0.55±0.3 ng/mL (range 0.13-1.5 ng/mL). The Spearman Correlation Coefficient was calculated to evaluate the correlation between dose and concentration. For whole and cut patches the correlation coefficient was 0.94 (P=0.005) and 0.72 (P=0.002), respectively. Doses ranging from 1.7 to 20 μg/kg/day using whole patches resulted in no plasma concentrations >2 ng/mL. However, a plasma concentration >2 ng/mL was achieved with a dose of 8.8 μg/kg/day delivered by a cut patch. In addition, the 2 samples that resulted in undetectable concentrations were taken from patients who were treated with cut patches. The results from this pilot study suggest that critically ill children absorb clonidine from transdermal patches, but the rate and extent of absorption appears to be more predictable with the use of whole patches compared to patches that have been cut.

Does Pediatric ICU (PICU) Residency Curriculum Match General Pediatric Practice (GP) Needs

Does Pediatric ICU (PICU) Residency Curriculum Match General Pediatric Practice (GP) Needs?

THE MISMATCH BETWEEN ATTENDING (ATTND) AND RESIDENT (RES) DESIRED EDUCATION DELIVERY STYLES IN PEDIATRIC INTENSIVE CARE (PICU) |[dagger]| 1774

PICU program directors must decide on the best educational delivery process to implement resident educational guidelines as published by the American Board of Pediatrics and the Society of Critical Care. Our goal was to evaluate both RES and ATTND determinations of the optimal RES (PL-2) rotation in an intensivist directed, non-fellow PICU. METHOD: Using an orthogonal array design, a survey was constructed which included 9 unique 4-factor-3-intensity educational delivery profiles. Factors and intensities included: RES CLINICAL supervision [structured, flexible, independent], RES PROCEDURE supervision [structured, flexible, independent], ATTND TEACHING STYLE [interactive, formal lectures, RES independent study], and EVALUATION OF RES [standardized test, oral interview, RES formal presentation]. Conjoint analysis (using SYSTAT) evaluated the utility score (0-9), importance (%total utility range for each factor) and variability (intergroup utility range differences) of factors and intensities. RESULTS: The educational delivery factor of highest utility and importance for RES (n=34) was CLINICAL(flexible) (6.0, 34%) but for ATTND (n=23) was PROCEDURE (flexible) (5.8, 39%). The educational delivery factor of least utility and importance for RES was PROCEDURE (structured) (4.7, 10%) but for ATTND was EVALUATION OF RES(test) (4.7, 13%). When analyzed by RES year, TEACHING STYLE (44%) and EVALUATION OF RES (24%) importance showed the highest variability. ATTND response did not significantly vary by specialty type nor yrs of experience. CONCLUSION: There is a mismatch between RES and ATTND in terms of preferred allowed flexibility in performing procedures. ATTND are least concerned with the evaluation of the RES performance. RES value most the clinical interactive nature of a PICU rotation. RES PICU rotations should be designed to maximize their utility for both RES and ATTND and require reevaluation if RES composition or ATTND teaching opportunity time decreases.