1Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD. 2Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD. 3Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 4Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD.
Crit Care Med. 2014 Jul;42(7):1592-600. doi: 10.1097/CCM.0000000000000326.
To examine pediatric intensivist sedation management, sleep promotion, and delirium screening practices for intubated and mechanically ventilated children.
An international, online survey of questions regarding sedative and analgesic medication choices and availability, sedation protocols, sleep optimization, and delirium recognition and treatment.
Member societies of the World Federation of Pediatric Intensive and Critical Care Societies were asked to send the survey to their mailing lists; responses were collected from July 2012 to January 2013.
Pediatric critical care providers.
Survey.
The survey was completed by 341 respondents, the majority of whom were from North America (70%). Twenty-seven percent of respondents reported having written sedation protocols. Most respondents worked in PICUs with sedation scoring systems (70%), although only 42% of those with access to scoring systems reported routine daily use for goal-directed sedation management. The State Behavioral Scale was the most commonly used scoring system in North America (22%), with the COMFORT score more prevalent in all other countries (39%). The most commonly used sedation regimen for intubated children was a combination of opioid and benzodiazepine (72%). Most intensivists chose fentanyl as their first-line opioid (66%) and midazolam as their first-line benzodiazepine (86%) and prefer to administer these medications as continuous infusions. Propofol and dexmedetomidine were the most commonly restricted medications in PICUs internationally. Use of earplugs, eye masks, noise reduction, and lighting optimization for sleep promotion was uncommon. Delirium screening was not practiced in 71% of respondent's PICUs, and only 2% reported routine screening at least twice a day.
The results highlight the heterogeneity in sedation practices among intensivists who care for critically ill children as well as a paucity of sleep promotion and delirium screening in PICUs worldwide.
调查小儿重症监护专家对插管和机械通气患儿镇静管理、促进睡眠和谵妄筛查的实践情况。
对镇静和镇痛药物选择和可用性、镇静方案、睡眠优化以及谵妄识别和治疗相关问题进行国际在线问卷调查。
世界小儿重症和危重病医学会的成员协会被要求将调查发给他们的邮寄名单；从 2012 年 7 月至 2013 年 1 月收集回复。
小儿重症护理提供者。
调查。
该调查由 341 名受访者完成，其中大多数来自北美（70%）。27%的受访者报告有书面镇静方案。大多数受访者在有镇静评分系统的 PICU 工作（70%），但只有 42%的有评分系统的人报告说每天常规用于目标导向的镇静管理。在北美，状态行为量表是最常用的评分系统（22%），而在所有其他国家，COMFORT 评分更为普遍（39%）。在插管患儿中最常用的镇静方案是阿片类药物和苯二氮䓬类药物的联合用药（72%）。大多数重症监护专家选择芬太尼作为一线阿片类药物（66%），咪达唑仑作为一线苯二氮䓬类药物（86%），并倾向于连续输注这些药物。丙泊酚和右美托咪定是国际上限制最严格的药物。促进睡眠的耳塞、眼罩、降噪和照明优化的使用并不常见。71%的受访者所在的 PICUs 没有进行谵妄筛查，只有 2%的人报告每天至少进行两次常规筛查。
结果突出了全球范围内重症监护专家在小儿镇静管理方面的实践存在差异，以及 PICUs 中睡眠促进和谵妄筛查的缺乏。
