Current United Kingdom sedation practice in pediatric intensive care
Current United Kingdom sedation practice in pediatric intensive care
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DOI：
10.1111/j.1460-9592.2006.02180.x
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发表时间：
2007-07-01
影响因子：
1.7
通讯作者：
Wolf, Andrew R.
中科院分区：
文献类型：
--
作者：
Jenkins, Ian A.;Playfor, Stephen D.;Wolf, Andrew R.
背景资料：本研究的目的是调查目前的做法，镇静，镇痛，神经肌肉阻滞在危重病患儿的儿科重症监护病房（PICU）在英国，并确定领域，值得进一步study.Methods：数据收集在一项前瞻性观察性研究338危重病患儿在20英国PICUs.Results：有相当大的变化在临床实践中。研究期间共使用了24种不同的镇静剂和镇痛剂。最常用的镇静镇痛药是咪达唑仑和吗啡。使用了四种不同的神经肌肉阻滞剂（NMB），最常用的是维库溴铵。心源性和非心源性儿童的治疗存在差异，但心源性组的婴儿和新生儿数量较多。30%的机械通气患者使用NMB。在13%的通气患者中报告了戒断症状，相对较早的住院时间;停用镇静剂（“逐渐减少”）显然没有益处。注意到在这种情况下使用可乐定。7.4%的人使用了人身限制。使用了异丙酚，但仅2.6%的患者使用了异丙酚，且年龄均超过4岁，且不超过2 mg.kg（-1）.h（-1）。没有副作用归因于'异丙酚综合征' noted.Conclusions：有相当大的异质性镇静技术。NMB用于这一人群的很大一部分。戒断症状与更高剂量的镇静剂和更长的住院时间相关，并且不能通过逐渐停用镇静剂（“逐渐减少”）得到改善。
Background: The aim of this study was to investigate the current practice of sedation, analgesia, and neuromuscular blockade in critically ill children on pediatric intensive care units (PICUs) in the UK and identify areas that merit further study.Methods: Data were gathered in a prospective observational study of 338 critically ill children in 20 UK PICUs.Results: There is considerable variation in clinical practice. A total of 24 different sedative and analgesic agents were used during the study. The most commonly used sedative and analgesic agents were midazolam and morphine. Four different neuromuscular blockers (NMBs) were used, most commonly vecuronium. There were differences in treatment between cardiac and noncardiac children, but there were a greater number of infants and neonates in the cardiac group. NMBs were used in 30% of mechanically ventilated patients. Withdrawal symptoms were reported in 13% of ventilated patients, relatively early in their stay; weaning sedative agents ('tapering') was apparently of no benefit. The use of clonidine in this setting was noted. Physical restraints were used in 7.4%. Propofol was used but in only 2.6% of patients, all over the age of 4 years, and not exceeding 2 mg.kg(-1).h(-1). No side effects attributable to 'propofol syndrome' were noted.Conclusions: There is considerable heterogeneity of sedation techniques. NMBs are used in a large portion of this population. Withdrawal symptoms were associated with higher doses of sedation and greater lengths of stay and were not ameliorated by withdrawing sedation gradually ('tapering').