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Sedation Management in Pediatric Patients with Acute Respiratory Failure (DCC)

急性呼吸衰竭 (DCC) 儿科患者的镇静管理

基本信息

批准号：
7364773
负责人：
DAVID WYPIJ
金额：
$ 23.74万
依托单位：
BOSTON CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-04-01 至 2013-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7364773
关键词：
Abstinence Syndrome Acute Acute respiratory failure Adverse event Algorithms Archives Benzodiazepines Biological Models Boston Caring Child Support Childhood Clinical Clinical Research Clinical Trials Data Monitoring Committees Confidentiality of Patient Information Consensus Critical Care Critical Illness Daily Data Data Analyses Data Coordinating Center Data Quality Data Reporting Data Set Databases Depressed mood Detection Development Drug Tolerance Education Effectiveness Emotional End Point Enrollment Ensure Environmental air flow Event Feedback Goals Health Hospital Costs Hospital Mortality Human Resources Infant Injury Intensive Care Intervention Investigation Length of Stay Life Maintenance Manuals Mechanical ventilation Monitor Multi-Institutional Clinical Trial Nature Neurologic Nurses Operative Surgical Procedures Opioid Organizational Change Outcome Patient Care Patients Pediatric Hospitals Pediatric Intensive Care Units Performance Pharmaceutical Preparations Preparation Protocols documentation Publications Quality Control Quality of life Randomized Randomized Clinical Trials Recovery Safety Sedation procedure Services Site Substance Withdrawal Syndrome Syndrome Testing Time Titrations Training Universities Update Visit Weaning Withdrawal Symptom Work abstracting cost cost effectiveness data management day experience innovation instrumentation prescription document prescription procedure programs quality assurance sedative

项目摘要

Description: (provided by applicant): Ensuring the safety and comfort of critically ill infants or children supported on mechanical ventilation is integral to the practice of pediatric critical care. Humane pediatric intensive care often includes sedation management. Although there are clear benefits in using sedation in pediatric patients who are unable to understand the imperative nature of critical care instrumentation and immobility, sedative use is associated with iatrogenic injury. Specifically, the medications used for sedation may depress spontaneous ventilation and prolong the duration of mechanical ventilation. Over time, drug tolerance develops and may precipitate iatrogenic withdrawal syndrome when sedation is no longer necessary. Prolonging the duration of mechanical ventilation and iatrogenic withdrawal syndrome add to the personal and financial burden of intensive care. This cluster randomized clinical trial will test an innovative approach to sedation management that includes: [a] team education and consensus on the use of sedatives in pediatric patients supported on mechanical ventilation, [b] team identification of the patient's trajectory of illness and daily prescription of a sedation goal, [c] a Nurse-Implemented Goal-Directed Comfort Algorithm that guides moment-to-moment titration of opioids and benzodiazepines, and [d] team feedback on sedation management performance. The intervention is an organizational change directed at all PICU clinicians. The unit of randomization is the PICU, the unit of inference is the patient, and we will control for center effects. Eighteen pediatric intensive care units (9 randomized to the sedation management intervention and 9 to continue to provide usual care) will enroll 2754 critically-ill infants and children supported on mechanical ventilation. We believe that patients managed per sedation protocol will experience fewer days of mechanical ventilation, less sedative exposure, fewer iatrogenic withdrawal symptoms, a shorter intensive care length of stay, less costs, and experience a better post-discharge quality of life and emotional health.

描述：（由申请人提供）：确保接受机械通气支持的危重婴儿或儿童的安全和舒适是儿科重症监护实践中不可或缺的一部分。人道的儿科重症监护通常包括镇静管理。尽管对于无法理解重症监护仪器和固定的必要性的儿科患者使用镇静剂有明显的好处，但镇静剂的使用与医源性损伤有关。具体来说，用于镇静的药物可能会抑制自主通气并延长机械通气的持续时间。随着时间的推移，药物耐受性逐渐形成，当不再需要镇静时，可能会引发医源性戒断综合征。机械通气持续时间延长和医源性戒断综合征增加了重症监护的个人和经济负担。这项整群随机临床试验将测试一种创新的镇静管理方法，其中包括：[a] 在机械通气支持的儿科患者中使用镇静剂的团队教育和共识，[b] 团队确定患者的疾病轨迹和镇静目标的每日处方，[c] 护士实施的目标导向舒适算法，指导阿片类药物的即时滴定和苯二氮卓类药物，以及 [d] 团队对镇静管理绩效的反馈。此次干预是针对所有 PICU 临床医生的组织变革。随机化单位是 PICU，推断单位是患者，我们将控制中心效应。 18 个儿科重症监护病房（9 个随机接受镇静管理干预，9 个继续提供常规护理）将招募 2754 名危重婴儿和儿童，接受机械通气支持。我们相信，按照镇静方案进行管理的患者将经历更少的机械通气天数、更少的镇静剂暴露、更少的医源性戒断症状、更短的重症监护住院时间、更少的费用，并体验更好的出院后生活质量和情绪健康。