Sedation during mechanical ventilation in infants and children: Dexmedetomidine versus midazolam
Sedation during mechanical ventilation in infants and children: Dexmedetomidine versus midazolam
复制标题
DOI：
10.1097/00007611-200405000-00007
复制
发表时间：
2004-05-01
影响因子：
1.1
通讯作者：
Berkenbosch, JW
中科院分区：
文献类型：
--
作者：
Tobias, JD;Berkenbosch, JW
工作背景：我们试图比较咪达唑仑与右美托咪定在婴儿和儿童机械通气期间镇静的疗效。方法：我们在三级护理中心的儿科重症监护室进行了一项前瞻性随机试验。需要机械通气的婴儿和儿童接受咪达唑仑（起始剂量为0.1 mg/kg/h）或右美托咪定（起始剂量为0.25或0.5 mug/kg/h）持续输注，并根据需要间断给予吗啡。采用Ramsay镇静评分、儿科重症监护室镇静评分、气管吸引评分及脑电双频监测评价镇静效果。通过临床镇静评分和脑电双频指数评估的镇静作用在3组中相当。咪达唑仑组给予36次吗啡推注，而0.25和0.5 mug/kg/h右美托咪定组分别给予29次和20次吗啡推注（咪达唑仑与0.5 mug/kg/h右美托咪定的P = 0.02）。咪达唑仑组和两个右美托咪定组的总吗啡使用量（mg/kg/24 h）分别为0.74 +/- 0.5、0.55 +/- 0.38和0.28 +/- 0.12（咪达唑仑与0.25右美托咪定的P =不显著，咪达唑仑与0.5右美托咪定的P = 0.01）。在两个右美托咪定组中，Ramsay评分为1的6例患者中有5例小于12个月，而只有1例大于12个月（P < 0.05）。结论：在0.25 mug/kg/h的剂量下，右美托咪定与0.22 mg/kg/h的咪达唑仑大致相当。在0.5 μ g/kg/h剂量下，右美托咪定提供了更有效的镇静，表现为需要更少的吗啡推注剂量、24小时补充吗啡需求减少以及Ramsay评分为1（镇静不足）的评估点总数和Ramsay评分为1的患者数量减少。
Background: We sought to compare the efficacy of midazolam versus dexmedetomidine for sedation during mechanical ventilation in infants and children.Methods: We performed a prospective, randomized trial in a pediatric intensive care unit in a tertiary care center. Infants and children requiring mechanical ventilation underwent a continuous infusion of either midazolam (starting dose of 0.1 mg/kg/h) or dexmedetomidine (starting dose of either 0.25 or 0.5 mug/kg/h) with intermittent morphine, as needed. The efficacy of sedation was assessed using the Ramsay sedation scale, pediatric intensive care unit sedation score, and the tracheal suctioning score as well as bispectral monitoring.Results: There were 10 patients in each group. Sedation as assessed by the clinical sedation scores and the bispectral index was equivalent in the 3 groups. There were 36 morphine boluses administered to the midazolam group versus 29 and 20 morphine boluses administered respectively to the 0.25 and 0.5 mug/kg/h dexmedetomidine groups (P = 0.02 for midazolam versus 0.5 mug/kg/h dexmedetomidine). Total morphine use (mg/kg/24 h) was 0.74 +/- 0.5, 0.55 +/- 0.38, and 0.28 +/- 0.12 in the midazolam and the two dexmedetomidine groups respectively (P = not significant for midazolam versus 0.25 dexmedetomidine, P = 0.01 for midazolam versus 0.5 dexmedetomidine). In the two dexmedetomidine groups, 5 of 6 patients who at some point had a Ramsay score of 1 were less than 12 months of age while only 1 was more than 12 months of age (P < 0.05).Conclusions: At a dose of 0.25 mug/kg/h, dexmedetomidine was approximately equivalent to midazolam at 0.22 mg/kg/h. At 0.5 mug/kg/h, dexmedetomidine provided more effective sedation as demonstrated by the need for fewer bolus doses of morphine, a decrease in the 24-hour requirements for supplemental morphine, as well as a decrease in the total number of assessment points with a Ramsay score of 1 (inadequate sedation) and the number of patients who had a Ramsay score of 1.