Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Pediatr Crit Care Med. 2012 Mar;13(2):131-5. doi: 10.1097/PCC.0b013e31820aba48.
To compare daily interruption vs. continuous sedative infusions in mechanically ventilated children with respect to lengths of mechanical ventilation and intensive care unit stay.
Prospective randomized controlled trial.
Pediatric intensive care unit of a tertiary care teaching and referral hospital.
One hundred two patients mechanically ventilated for >48 hrs.
Patients were randomized to receive either continuous (group 1) or interrupted (group 2) sedative infusion (midazolam bolus of 0.1 mg/kg, followed by infusion, to achieve a Ramsay score of 3-4). Each patient in group 2 had daily interruption of infusion at 8:00 AM till he/she became fully awake (response to verbal commands) or so agitated/uncomfortable that he/she needed restarting of infusion (whichever was earlier) at a dose 50% less than the previous dose. Primary outcome variables were the lengths of mechanical ventilation and intensive care unit stay, while the number and percentage of days awake on sedative infusions, frequency of adverse events, and total dose of sedatives required were the secondary outcome variables.
Of the 102 patients included in the study, 56 were randomized into the continuous sedation protocol and 46 into the interrupted sedation protocol. Both were statistically similar with respect to demography, primary diagnosis, severity of illness score (Pediatric Risk of Mortality I and III), indication for mechanical ventilation, and initial ventilatory variables except that the patients under the interrupted arm had lower peak inspiratory pressure and positive end-expiratory pressure requirements at the start of ventilation (p = .002 and p = .028, respectively). The mean (SD) length of mechanical ventilation in the interrupted sedation protocol was significantly less than that in the continuous sedation protocol (7.0 ± 4.8 days vs. 10.3 ± 8.4 days; p = .021). Similarly, the difference in the median duration of pediatric intensive care unit stay was significantly less in the interrupted sedation as compared to the continuous sedation protocol (10.7 days vs. 14.0 days; p = .048). The mean total dose of midazolam and the total calculated cost of midazolam in the former were significantly less compared to those of the latter (7.1 ± 4.7 mL vs. 10.9 ± 6.9 mL, p = .002; 4827 ± 5445 rupees vs. 13,865 ± 25,338 rupees, p = .020). The frequencies of adverse events in both the groups were however similar.
The length of mechanical ventilation, duration of intensive care unit stay, total dose of midazolam, and average calculated cost of the therapy were significantly reduced in the interrupted as compared to the continuous group of sedation.
比较机械通气患儿每日间断镇静输注与连续镇静输注在机械通气时间和重症监护病房（ICU）入住时间方面的差异。
前瞻性随机对照试验。
一家三级教学和转诊医院的儿科重症监护病房。
102 例机械通气时间>48 小时的患者。
患者随机分为连续镇静组（1 组）或间断镇静组（2 组）（咪达唑仑 0.1mg/kg 推注，然后持续输注，使 Ramsay 镇静评分达到 3-4 分）。2 组中的每位患者每天上午 8 点停止输注，直到患者完全清醒（对口头指令有反应）或因烦躁不安或不适而需要重新开始输注（以先发生者为准），剂量为前一剂量的 50%。主要结局变量为机械通气时间和 ICU 入住时间，次要结局变量为镇静输注期间清醒的天数和百分比、不良事件的发生频率以及所需镇静剂的总剂量。
本研究共纳入 102 例患者，其中 56 例随机分为连续镇静组，46 例随机分为间断镇静组。两组在人口统计学、主要诊断、疾病严重程度评分（小儿死亡风险评分 I 和 III）、机械通气指征和初始通气变量方面均无统计学差异，除间断镇静组患者在开始通气时的吸气峰压和呼气末正压要求较低（p=0.002 和 p=0.028）外。间断镇静组机械通气时间的平均值（标准差）明显短于连续镇静组（7.0±4.8 天 vs. 10.3±8.4 天；p=0.021）。同样，间断镇静组与连续镇静组患儿 ICU 入住时间中位数的差异也有统计学意义（10.7 天 vs. 14.0 天；p=0.048）。与后者相比，前者咪达唑仑的总剂量和总计算费用明显减少（7.1±4.7ml vs. 10.9±6.9ml，p=0.002；4827±5445 卢比 vs. 13865±25338 卢比，p=0.020）。但两组的不良事件发生率相似。
与连续镇静组相比，间断镇静组的机械通气时间、ICU 入住时间、咪达唑仑总剂量和治疗平均计算费用均显著降低。
