Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure.
Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure.
复制标题
急性呼吸衰竭患儿体外膜肺氧合的镇静管理。
DOI：
10.1097/ccm.0000000000002540
复制
发表时间：
2017-10
影响因子：
8.8
通讯作者：
Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators
中科院分区：
文献类型：
--
作者：
Schneider JB;Sweberg T;Asaro LA;Kirby A;Wypij D;Thiagarajan RR;Curley MAQ;Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators
To describe sedation management in children supported on extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. Secondary analysis of prospectively collected data from a multicenter randomized trial of sedation (RESTORE). 21 U.S. Pediatric Intensive Care Units. 1255 children, 2 weeks to 17 years old, with moderate/severe PARDS. Sedation managed per usual care or RESTORE protocol. Sixty-one (5%) RESTORE patients with moderate/severe PARDS were supported on ECMO, including 29 managed per RESTORE protocol. Most ECMO patients received neuromuscular blockade (46%) or were heavily sedated with SBS scores −3/−2 (34%) by ECMO day 3. Median opioid and benzodiazepine doses on the day of cannulation, 0.15 mg/kg/hr (3.7 mg/kg/day) and 0.11 mg/kg/hr (2.8 mg/kg/day), increased by 36% and 58%, respectively, by ECMO day 3. In the 41 patients successfully decannulated prior to study discharge, patients were receiving 0.40 mg/kg/hr opioids (9.7 mg/kg/day) and 0.39 mg/kg/hr benzodiazepines (9.4 mg/kg/day) at decannulation, an increase from cannulation of 108% and 192%, respectively (both p<0.001). ECMO patients experienced more clinically significant iatrogenic withdrawal than moderate/severe PARDS patients managed without ECMO support (p<0.001). Compared to ECMO patients managed per RESTORE protocol, usual care ECMO patients received more opioids during the study period (mean cumulative dose of 183.0 vs 89.8 mg/kg; p=0.02), over 6.5 greater exposure days (p=0.002) with no differences in wakefulness or agitation. In children, the initiation of ECMO support is associated with deep sedation, substantial sedative exposure, and increased incidence of iatrogenic withdrawal syndrome. A standardized, goal-directed, nurse-driven sedation protocol may help mitigate these effects.
