Patient, Process, and System Predictors of Iatrogenic Withdrawal Syndrome in Critically Ill Children.
Patient, Process, and System Predictors of Iatrogenic Withdrawal Syndrome in Critically Ill Children.
复制标题
危重儿童医源性戒断综合征的患者、过程和系统预测因素。
DOI：
10.1097/ccm.0000000000001953
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发表时间：
2017
影响因子：
8.8
通讯作者：
RandomizedEvaluationofSedationTitrationForRespiratoryFailureStudyInvestigators
中科院分区：
文献类型：
--
作者：
Best,KaitlinM;Wypij,David;Asaro,LisaA;Curley,MarthaAQ;RandomizedEvaluationofSedationTitrationForRespiratoryFailureStudyInvestigators
目的：建立危重患儿医源性戒断综合征危险因素的多维预测模型。设计：对呼吸衰竭临床试验镇静滴定随机评价的前瞻性数据进行二次分析。患者：因急性呼吸衰竭在机械通气期间接受大于或等于5天镇静治疗的儿童。干预措施：呼吸衰竭镇静滴定的随机评估研究测试了护士主导的、目标导向的镇静方案对临床结果的影响。在这个二次分析中没有额外的干预。测量和主要结果：数据包括31个picu的1157名儿童。医源性戒断综合征被定义为在阿片类药物开始断奶后至少有两个戒断评估工具-版本1评分大于或等于3。采用Logistic回归和广义估计方程来解释不同地点的聚类，以评估医源性戒断综合征的患者、过程和医疗保健系统风险因素。医源性戒断综合征的受试者（544/ 1157;47%）更年轻，更有可能存在认知或功能障碍。他们还接受了更高剂量的镇静剂和更长的暴露时间。在多变量分析中，医源性戒断综合征的重要预测因素包括年龄较小、既往存在认知障碍、较高的断奶前平均每日阿片类药物剂量、较长的镇静持续时间、接受三种或三种以上的断奶前镇静药物、较高的护理工作量以及更多的一对一护士配备。结论：医源性戒断综合征在危重疾病恢复期的儿童中很常见，几个危险因素具有预测性，包括患者特征、镇静暴露、额外镇静药物和系统水平因素。高危患者可以在断奶前识别，以更好地预防高危患者的医源性戒断综合征。
Objective:To generate a multidimensional predictive model of risk factors for iatrogenic withdrawal syndrome in critically ill children.Design:Secondary analysis of prospective data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial.Setting:PICU.Patients:Children who received greater than or equal to 5 days of sedation during mechanical ventilation for acute respiratory failure.Interventions:The Randomized Evaluation of Sedation Titration for Respiratory Failure study tested the effect of a nurse-led, goal-directed sedation protocol on clinical outcomes. There was no additional intervention in this secondary analysis.Measurements and Main Results:Data included 1,157 children from 31 PICUs. Iatrogenic withdrawal syndrome was defined as having at least two Withdrawal Assessment Tool–Version 1 scores greater than or equal to 3 after the start of opioid weaning. Logistic regression with generalized estimating equations to account for clustering by site was used to evaluate patient, process, and healthcare system risk factors for iatrogenic withdrawal syndrome. Subjects with iatrogenic withdrawal syndrome (544/1,157; 47%) were younger and more likely to have preexisting cognitive or functional impairment. They also received higher sedative doses and longer exposure periods. In multivariable analyses, significant predictors of iatrogenic withdrawal syndrome included younger age, preexisting cognitive impairment, higher preweaning mean daily opioid dose, longer duration of sedation, receipt of three or more preweaning sedative classes, higher nursing workload, and more one-to-one nurse staffing.Conclusions:Iatrogenic withdrawal syndrome is common in children recovering from critical illness, and several risk factors are predictive, including patient characteristics, sedative exposure, additional sedative agents, and system-level factors. High-risk patients could be identified before weaning to better prevent iatrogenic withdrawal syndrome among at-risk patients.
DOI：
10.1016/b978-0-12-456270-7.x5001-2
发表时间：
1988
期刊：
Immunology today
影响因子：
--
作者：
K. Low
通讯作者：
K. Low
快速、轻松地对大型线性双链 DNA 和超螺旋质粒 DNA 进行测序
DOI：
--
发表时间：
1985
期刊：
影响因子：
--
作者：
R. Zagursky;K. Baumeister;N. Lomax;M. Berman
通讯作者：
M. Berman