Ista Erwin, de Hoog Matthijs, Tibboel Dick, van Dijk Monique
Clinical Researcher, Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, PO Box 2060, Office Sk-3146, Rotterdam 3000 CB, The Netherlands.
J Clin Nurs. 2009 Sep;18(17):2511-20. doi: 10.1111/j.1365-2702.2009.02836.x. Epub 2009 Jul 8.
To study the effects of the introduction of a sedation treatment protocol for children in intensive care, including nurses' compliance.
While several sedation guidelines for adults and children have been developed and implemented, there is little evidence on use of sedation protocols in critically ill infants.
Pretest-posttest intervention study.
Administered sedatives and analgesics over the first seven days of admission were documented for convenience samples, before (n = 27) and after (n = 29) implementation of standard sedation assessments and a sedation protocol. Sedation was assessed with the COMFORT behaviour scale, Nurse Interpretation of Sedation Score and the Visual Analogue Scale for three-month periods, both pretest and posttest. Starting 21 months after the posttest, nurses' compliance with the sedation protocol, as well as administered sedatives and analgesics were evaluated for 12 months.
Infants in the posttest period received significantly more midazolam and morphine. The proportion of patients adequately sedated on the grounds of COMFORT scores had increased from 63% pretest to 72% posttest and to 75% in the long run. Adequate sedation as judged from the sedation protocol cutoffs was found in 71% of the assessments. In 45% of assessments indicating undersedation, the infusion rate had been increased on the guidance of the protocol. A survey among staff revealed that most considered the sedation protocol comprehensible and useful.
This study showed that regular sedation assessment in critically ill children was feasible and had become standard practice two years after the first posttest. There is insufficient evidence to conclude whether implementation of a sedation treatment protocol indeed improves sedation treatment.
This sedation protocol provides decision trees for increasing or weaning of sedatives in both haemodynamically stable and unstable patients. It standardizes sedation management and allows nurses to adapt medication themselves.
研究在重症监护中引入儿童镇静治疗方案的效果，包括护士的依从性。
虽然已经制定并实施了多项成人和儿童镇静指南，但关于危重症婴儿使用镇静方案的证据很少。
前后测干预研究。
记录入院头七天给予的镇静剂和镇痛药，用于便利样本，在实施标准镇静评估和镇静方案之前（n = 27）和之后（n = 29）。在前后测期间，每三个月用舒适行为量表、护士镇静评分解读和视觉模拟量表评估镇静情况。在后测21个月后开始，对护士对镇静方案的依从性以及给予的镇静剂和镇痛药进行为期12个月的评估。
后测期间的婴儿接受了显著更多的咪达唑仑和吗啡。根据舒适评分充分镇静的患者比例从测试前的63%增加到测试后的72%，长期来看增加到75%。根据镇静方案临界值判断，在71%的评估中发现了充分镇静。在45%表明镇静不足的评估中，在方案指导下提高了输注速率。对工作人员的一项调查显示，大多数人认为镇静方案易于理解且有用。
本研究表明，对危重症儿童进行定期镇静评估是可行的，并且在首次后测两年后已成为标准做法。没有足够的证据得出实施镇静治疗方案是否确实改善了镇静治疗的结论。
该镇静方案为血流动力学稳定和不稳定的患者提供了增加或减少镇静剂的决策树。它规范了镇静管理，并允许护士自行调整用药。
