Verlaat Carin W M, Heesen Ger P, Vet Nienke J, de Hoog Matthijs, van der Hoeven Johannes G, Kox Matthijs, Pickkers Peter
Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Paediatr Anaesth. 2014 Feb;24(2):151-6. doi: 10.1111/pan.12245. Epub 2013 Aug 24.
To study the feasibility of daily interruption of sedatives in critically ill children.
Prospective randomized controlled open-label trial, performed in a pediatric intensive care unit of a tertiary care teaching and referring hospital. 30 children (0-12 years) receiving mechanically ventilation for >24 h were included. In the intervention group, all sedatives were stopped daily and restarted when COMFORT-behavior score ≥17. The control group received standard care. Primary end points were amounts of sedatives and number of bolus medications in the first 3 days after enrollment and number of (near) incidents. Secondary end points were duration of mechanical ventilation, length of stay in pediatric intensive care, and changes in COMFORT-behavior score.
Midazolam and morphine use were lower in the intervention group compared with the control group (P = 0.007 and P = 0.02, respectively), whereas the number of bolus medications did not differ between groups. Two complications were recorded: one patient (intervention group) lost his intravenous line, and one patient (control group) had an unplanned extubation. Duration of mechanical ventilation was significantly shorter in the intervention group compared with the control group (median [interquartile range] of 4 [3-8] and 9 [4-10] days, respectively, P = 0.03). Length of stay in the PICU in the intervention group was significantly shorter than in the control group (median [interquartile range] of 6 [4-9] and 10 [7-15] days, respectively, P = 0.01).
Daily interruption of sedatives in critically ill children is feasible, results in decreased use of sedation, earlier extubation, and shorter length of stay.
研究在危重症儿童中每日中断使用镇静剂的可行性。
在一家三级医疗教学及转诊医院的儿科重症监护病房进行前瞻性随机对照开放标签试验。纳入30名接受机械通气超过24小时的0至12岁儿童。干预组每日停用所有镇静剂，当舒适行为评分≥17分时重新开始使用。对照组接受标准治疗。主要终点为入组后前3天镇静剂用量、推注药物数量以及（近）不良事件数量。次要终点为机械通气时间、儿科重症监护病房住院时间以及舒适行为评分的变化。
与对照组相比，干预组咪达唑仑和吗啡的使用量较低（分别为P = 0.007和P = 0.02），而两组间推注药物数量无差异。记录到两例并发症：一名患者（干预组）静脉输液管脱落，一名患者（对照组）意外拔管。与对照组相比，干预组的机械通气时间显著缩短（中位数[四分位间距]分别为4[3 - 8]天和9[4 - 10]天，P = 0.03）。干预组在儿科重症监护病房的住院时间显著短于对照组（中位数[四分位间距]分别为6[4 - 9]天和10[7 - 15]天，P = 0.01）。
在危重症儿童中每日中断使用镇静剂是可行的，可减少镇静剂使用、提前拔管并缩短住院时间。
