Use of oral clonidine for sedation in ventilated paediatric intensive care patients
Use of oral clonidine for sedation in ventilated paediatric intensive care patients
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DOI：
10.1007/s00134-004-2319-0
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发表时间：
2004-08-01
影响因子：
38.9
通讯作者：
Murdoch, IA
中科院分区：
文献类型：
--
作者：
Arenas-López, S;Riphagen, S;Murdoch, IA
目标.我们的目的是记录我们的经验，口服可乐定作为一种镇静剂时，联合静脉注射吗啡和劳拉西泮在一组机械通气的儿童单器官，呼吸衰竭。特别是，我们的目标是建立口服剂量，血浆浓度和镇静作用之间的关系，其次，记录副作用的概况。设计72小时内的前瞻性队列研究。设置.地区儿科重症监护室。患者和参与者。24名儿童入组（中位年龄3个月），其中10名被排除（6名因72小时前拔管，3名镇静失败，1名违反方案）。测量和结果。采用气相色谱质谱法测定血浆可乐定，并采用COMFORT评分评估镇静作用。每8小时使用3-5 μ g/kg的剂量，血浆浓度在约41小时达到平台，平均值为1.38 ng/ml（95%置信区间1.0-1.8）。在82%（837/1022小时）的研究期间达到了充分镇静;然而，在意向治疗基础上进行分析时，这一比例降至70.3%。吗啡（P = 0.02）和劳拉西泮（P = 0.003）的平均每小时需求量随之总体下降。未记录心动过缓、低血压或高血压发作。结论.口服可乐定与吗啡、劳拉西泮联合应用对单器官呼吸衰竭患儿可能是一种安全有效的镇静剂。该药物在该患者组中也可能表现出阿片类药物和苯二氮卓类药物的保护作用。需要进行全面的药代动力学研究。
Objectives. We aimed to document our experience with oral clonidine when used as a sedative in combination with intravenous morphine and lorazepam in a group of mechanically ventilated children with single-organ, respiratory failure. In particular, our objectives were to establish the relationship between oral dose, plasma concentration, and sedative effect, and second, to document the side-effect profile. Design. Prospective, cohort study over a 72-h period. Setting. Regional paediatric intensive care unit. Patients and participants. Twenty-four children were enrolled (median age 3 months) of whom ten were excluded (six due to extubation before 72 h, three sedation failures, one protocol violation). Measurements and results. Plasma clonidine was measured using gas chromatography mass spectrometry, and sedation assessed using the COMFORT score. Using a dose of 3-5 mug/kg every 8 h, plasma concentrations appeared to plateau at approximately 41 h giving a mean value of 1.38 ng/ml (95% confidence interval 1.0-1.8). Adequate sedation was achieved during 82% (837/1022 h) of the study period; however, this decreased to 70.3% when analysed on an intention-to-treat basis. There was a concomitant overall decrease in the average hourly requirements for both morphine (P = 0.02) and lorazepam (P = 0.003). There were no documented episodes of bradycardia, hypotension or hyperglycaemia. Conclusions. Oral clonidine may be a safe and effective sedative in combination with morphine and lorazepam for young children with single-organ, respiratory failure. This agent may also exhibit opioid and benzodiazepine sparing effects in this patient group. A full pharmacokinetic study is warranted.