Pediatrics and Clinical Ethics, Université de Montréal, Montréal, Québec, Canada.
J Pediatr. 2011 Aug;159(2):206-10. doi: 10.1016/j.jpeds.2011.01.022. Epub 2011 Feb 26.
To clarify the use of end-of-life comfort medications or neuromuscular blockers (NMBs) in culturally different neonatal intensive care units (NICUs).
Review of medical files of newborns > 22 weeks gestation who died in the delivery room or the NICU during 12 months in four NICUs (Chicago, Milwaukee, Montreal, and Groningen). We compared use of end-of-life comfort medications and NMBs.
None of the babies who died in the delivery room received comfort medications. The use of opiods (77%) or benzodiazepines (41%) around death was similar in all NICUs. Increasing this medication around extubation occurred most often in Montreal, rarely in Milwaukee and Groningen, and never in Chicago. Comfort medications use had no significant impact on the time between extubation and death. NMBs were never used around death in Chicago, once in Montreal, and more frequently in Milwaukee and Groningen. Initiation of NMB after extubation occurred only in Groningen.
Comfort medications were administered to almost all dying infants in each NICU. Some, but not all, centers were comfortable increasing these medications around or after extubation. In three centers, NMBs were at times present at the time of death. However, only in Holland were NMBs initiated after extubation.
阐明在文化背景不同的新生儿重症监护病房（NICU）中使用临终舒适药物或神经肌肉阻滞剂（NMBs）的情况。
回顾了在四个 NICU（芝加哥、密尔沃基、蒙特利尔和格罗宁根）的 12 个月内，在产房或 NICU 死亡的胎龄>22 周的新生儿的医疗档案。我们比较了临终舒适药物和 NMBs 的使用情况。
在产房死亡的婴儿均未使用临终舒适药物。所有 NICU 中，接近死亡时使用阿片类药物（77%）或苯二氮䓬类药物（41%）的情况相似。在蒙特利尔，拔管前后增加这些药物的情况最为常见，在密尔沃基和格罗宁根很少见，在芝加哥从未发生过。使用临终舒适药物对拔管与死亡之间的时间没有显著影响。在芝加哥，NMBs 从未在死亡时使用过，在蒙特利尔使用过一次，在密尔沃基和格罗宁根使用过更频繁。只有在格罗宁根，拔管后才开始使用 NMB。
每个 NICU 中的几乎所有临终婴儿都使用了临终舒适药物。一些中心（但不是所有中心）在拔管前后增加这些药物时感到舒适。在三个中心，NMB 在死亡时有时存在。然而，只有在荷兰，NMB 是在拔管后开始使用的。
