Frequencies, Modalities, Doses and Duration of Computerized Prescriptions for Sedative, Analgesic, Anesthetic and Paralytic Drugs in Neonates Requiring Intensive Care: A Prospective Pharmacoepidemiologic Cohort Study in 30 French NICUs From 2014 to 2020.
Frequencies, Modalities, Doses and Duration of Computerized Prescriptions for Sedative, Analgesic, Anesthetic and Paralytic Drugs in Neonates Requiring Intensive Care: A Prospective Pharmacoepidemiologic Cohort Study in 30 French NICUs From 2014 to 2020.
复制标题
DOI：
10.3389/fphar.2022.939869
复制
发表时间：
2022
影响因子：
5.6
通讯作者：
Durrmeyer, Xavier
中科院分区：
文献类型：
--
作者：
Tauzin, Manon;Gouyon, Beatrice;Hirt, Deborah;Carbajal, Ricardo;Gouyon, Jean-Bernard;Brunet, Anne-Claire;Ortala, Matthieu;Goro, Seydou;Jung, Camille;Durrmeyer, Xavier
目的：对于危重新生儿使用的镇痛剂、镇静剂、麻醉剂和麻药的剂量尚无共识。对处方做法进行大规模、详细的药物流行病学研究是未来研究的先决条件。本研究旨在从计算机化的处方记录中描述在新生儿重症监护病房(NICU)住院的新生儿中这些药物类别的详细处方，并比较不同胎龄的处方。材料和方法：我们纳入了从2014年到2020年在30个法国III级病房中需要重症监护的所有新生儿，并使用了计算机处方的止痛剂、镇静剂、麻醉剂或麻风剂。我们描述了处方的频率、给药方法、伴随药物处方和给药方案，并对它们在不同孕周进行了比较。结果：65555例新生儿中，29340例(44.8%)至少服用一种止痛药(对乙酰氨基酚占37.2%，阿片类药物占17.8%)、镇静剂(9.8%)、麻醉剂(8.5%)和(或)麻药(1%)。在28周前出生的早产儿中，3,771/4,283人(88.0%)至少开了一种药物：69.7%的阿片类药物，41.2%的镇静剂，32.5%的麻醉药和5.8%的麻药。最常见的处方药物是舒芬太尼(10.3%)和吗啡(8.0%)用于阿片类药物，咪达唑仑(9.3%)用于镇静，氯胺酮(5.7%)和异丙酚(3.3%)用于麻醉药。在大多数新生儿中，阿片类药物和镇静剂是以持续输注的方式开出的，而麻醉药是以单次剂量开出的。阿片类药物、镇静剂和麻痹药大多是与另一种药物联合开出的。不同胎龄的剂量差异很大，但在有限的范围内。孕周与处方的使用频率、累积剂量和持续时间呈负相关。例如，在妊娠28周和37周出生的婴儿中，吗啡处方的累积剂量中位数分别为2601(848-6750)和934(434-2679)微克/公斤，持续时间的中位数(IQR)分别为7(3-15)和3(2-5)天(p-≥；0.001)。结论：NICU患者使用镇痛剂、镇静剂、麻醉剂或麻药的处方较多，且常合并使用。较低的胎龄与较高的频率、较长的持续时间和较高的累积剂量有关。需要进行剂量发现研究，以确定个体化给药方案，并根据接收的累积剂量对长期神经发育结果进行研究。
Objectives: No consensus exists about the doses of analgesics, sedatives, anesthetics, and paralytics used in critically ill neonates. Large-scale, detailed pharmacoepidemiologic studies of prescription practices are a prerequisite to future research. This study aimed to describe the detailed prescriptions of these drug classes in neonates hospitalized in neonatal intensive care units (NICU) from computerized prescription records and to compare prescriptions by gestational age. Materials and Methods: We included all neonates requiring intensive care in 30 French level III units from 2014 through 2020 with a computerized prescription for an analgesic, sedative, anesthetic, or paralytic agent. We described frequencies of prescription, methods of administration, concomitant drug prescriptions, and dosing regimen, and compared them across gestational ages. Results: Among 65,555 neonates, 29,340 (44.8%) were prescribed at least one analgesic (acetaminophen in 37.2% and opioids in 17.8%), sedative (9.8%), anesthetic (8.5%), and/or paralytic agent (1%). Among preterm infants born before 28 weeks, 3,771/4,283 (88.0%) were prescribed at least one of these agents: 69.7% opioids, 41.2% sedatives, 32.5% anesthetics, and 5.8% paralytics. The most frequently prescribed agents were sufentanil (in 10.3% of neonates) and morphine (in 8.0% of neonates) for opioids, midazolam (9.3%) for sedatives, ketamine (5.7%) and propofol (3.3%) for anesthetics. In most neonates, opioids and sedatives were prescribed as continuous infusion, whereas anesthetics were prescribed as single doses. Opioids, sedatives and paralytics were mostly prescribed in association with another agent. Doses varied significantly by gestational age but within a limited range. Gestational age was inversely related to the frequency, cumulative dose and duration of prescriptions. For example, morphine prescriptions showed median (IQR) cumulative doses of 2601 (848–6750) vs. 934 (434–2679) µg/kg and median (IQR) durations of 7 (3–15) vs. 3 (2–5) days in infants born <28 vs. ≥ 37 weeks of gestation, respectively (p-value<0.001). Conclusion: The prescriptions of analgesic, sedative, anesthetic, or paralytic agent were frequent and often combined in the NICU. Lower gestational age was associated with higher frequencies, longer durations and higher cumulative doses of these prescriptions. Dose-finding studies to determine individualized dosing regimens and studies on long-term neurodevelopmental outcome according to received cumulative doses are required.
登录
查看更多内容
影响因子：
120.7
作者：
Durrmeyer, Xavier;Breinig, Sophie;Danan, Claude
通讯作者：
Danan, Claude
影响因子：
5.1
作者：
Borenstein-Levin, Iron;Synnes, Anne;Shah, Prakesh S.
通讯作者：
Shah, Prakesh S.
影响因子：
2
作者：
Gouyon, B.;Iacobelli, S.;Gouyon, J. B.
通讯作者：
Gouyon, J. B.
影响因子：
2.9
作者：
Alam, Azeem;Suen, Ka Chun;Ma, Daqing
通讯作者：
Ma, Daqing
影响因子：
2.1
作者：
Hall RW;Anand KJ
通讯作者：
Anand KJ