Jin Hyun Seung, Yum Mi Sun, Kim Seoung Lan, Shin Hye Young, Lee Eun Hee, Ha Eun Ju, Hong Soo Jong, Park Seong Jong
Department of Pediatrics, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
J Korean Med Sci. 2007 Aug;22(4):693-7. doi: 10.3346/jkms.2007.22.4.693.
Sedation is often necessary to optimize care for critically ill children requiring mechanical ventilation. If too light or too deep, however, sedation can cause significant adverse reactions, making it important to assess the degree of sedation and maintain its optimal level. We evaluated the efficacy of the COMFORT scale in assessing optimal sedation in critically ill children requiring mechanical ventilation. We compared 12 month data in 21 patients (intervention group), for whom we used the pediatric intensive care unit (PICU) sedation protocol of Asan Medical Center (Seoul, Korea) and the COMFORT scale to maintain optimal sedation, with the data in 20 patients (control group) assessed before using the sedation protocol and the COMPORT scale. Compared with the control group, the intervention group showed significant decreases in the total usage of sedatives and analgesics, the duration of mechanical ventilation (11.0 days vs. 12.5 days) and PICU stay (15.0 days vs. 19.5 days), and the development of withdrawal symptoms (1 case vs. 7 cases). The total duration of sedation (8.0 days vs. 11.5 days) also tended to decrease. These findings suggest that application of protocol-based sedation with the COMPORT scale may benefit children requiring mechanical ventilation.
对于需要机械通气的危重症儿童，镇静常常是优化治疗的必要手段。然而，镇静过浅或过深都会引起严重的不良反应，因此评估镇静程度并维持最佳水平非常重要。我们评估了COMFORT量表在评估需要机械通气的危重症儿童最佳镇静状态方面的有效性。我们比较了21例患者（干预组）12个月的数据，我们使用韩国首尔峨山医学中心的儿科重症监护病房（PICU）镇静方案和COMFORT量表来维持最佳镇静状态，与20例患者（对照组）在使用镇静方案和COMFORT量表之前评估的数据进行比较。与对照组相比，干预组的镇静剂和镇痛药总用量、机械通气时间（11.0天对12.5天）和PICU住院时间（15.0天对19.5天）以及戒断症状的发生率（1例对7例）均显著降低。镇静总时长（8.0天对11.5天）也有下降趋势。这些发现表明，应用基于方案的镇静并结合COMFORT量表可能会使需要机械通气的儿童受益。
