A Learning Health System Approach to Precision Sedation and Analgesia in Critically-Ill Children

项目摘要 在美国，每年约有50万儿童患有危重疾病，超过三分之一 将接受镇静止痛药的持续输注，如阿片类药物或右美托咪定。 这类药物通常用于治疗严重的疼痛，减轻危重疾病的负担 重症监护病房中与侵入性器官支持提供和手术相关的焦虑。然而， 目前还没有广泛接受的标准来管理这些有效的神经活性药物和 几项研究表明，儿童接受的这些药物太少或太多近一半 他们被施药的时间。传统剂量策略中的这种不精确会导致不良事件， 包括急性生理恶化、药物耐受和依赖、长期患病和住院 以及侵入性支持的危及生命的并发症，如非计划拔管和拔管后 呼吸道阻塞。证据还表明，接触这些药物的时间相对较短可能会 不利于长期的神经发育。更精确的给药策略 孩子是需要的，这是一个重大问题

PROJECT ABSTRACT Approximately 500,000 children suffer critical illness every year in the United States and more than one third will receive a continuous infusion of a sedative-analgesic medication such as an opioid or dexmedetomidine. Such drugs are commonly administered to ease the burden of critical illness by treating serious pain and anxiety associated with invasive organ support delivery and procedures in the intensive care unit. However, there are no widely-accepted standards for the administration of these potent neuroactive medications and several studies have demonstrated that children receive too little or too much of these medications nearly half of the time they are administered. This imprecision in conventional dosing strategies leads to adverse events, including acute physiologic deterioration, drug tolerance and dependency, prolonged illness and hospitalization and life-threatening complications of invasive support such as unplanned extubation and post-extubation airway obstruction. Evidence also indicates that relatively short exposures to these medications may be detrimental to long-term neurodevelopment. More precise strategies for administering these medications to children are needed and this is an issue of major