Ducharme Céline, Carnevale Franco A, Clermont Marie-Sol, Shea Sarah
Pediatric Intensive Care Unit, Montreal Children's Hospital, 2300 Tupper, Montreal, Que. H3H 1P3, Canada.
Intensive Crit Care Nurs. 2005 Jun;21(3):179-86. doi: 10.1016/j.iccn.2004.09.003. Epub 2005 Jan 18.
The aim of this study was to identify the optimal rates at which opioids and benzodiazepines should be weaned in order to prevent withdrawal reactions in the pediatric intensive care unit (PICU). This study follows an earlier investigation that developed a graphical analysis method for examining behavioral signs of withdrawal in relation to changes in opioid and benzodiazepine administration. This method was utilized in this present study for a prospective sample of all patients admitted to a tertiary/quaternary level PICU within a 4-week interval (n=27). The findings of this study indicate that the required rate of weaning (in order to prevent withdrawal reactions) is related to the number of days the child has been on a continuous infusion of opioids and/or benzodiazepines. Adverse withdrawal reactions were prevented when the daily rate of weaning did not exceed: 20% for children receiving continuous infusions for 1-3 days; 13-20% for 4-7 days; 8-13% for 8-14 days; 8% for 15-21 days; and 2-4% for more than 21 days of infusions. The authors recommend that the rate of weaning of opioids and benzodiazepines in critically ill children be tailored to the length of time the child received continuous infusions of these agents.
本研究的目的是确定阿片类药物和苯二氮䓬类药物的最佳减量速率，以预防儿科重症监护病房（PICU）中的戒断反应。本研究延续了一项早期调查，该调查开发了一种图形分析方法，用于检查与阿片类药物和苯二氮䓬类药物给药变化相关的戒断行为体征。本研究采用该方法对在4周内入住三级/四级PICU的所有患者的前瞻性样本（n = 27）进行了研究。本研究结果表明，所需的减量速率（为预防戒断反应）与儿童持续输注阿片类药物和/或苯二氮䓬类药物的天数有关。当每日减量速率不超过以下标准时，可预防不良戒断反应：接受持续输注1 - 3天的儿童为20%；4 - 7天为13 - 20%；8 - 14天为8 - 13%；15 - 21天为8%；输注超过21天为2 - 4%。作者建议，重症患儿阿片类药物和苯二氮䓬类药物的减量速率应根据患儿接受这些药物持续输注的时间长短进行调整。
