Achuff Barbara-Jo, Nicolson Susan C, Elci Okan U, Zuppa Athena F
1Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 2Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 3Biostatistics and Data Management Core, The Children's Hospital of Philadelphia, Philadelphia, PA.
Pediatr Crit Care Med. 2015 Jun;16(5):440-7. doi: 10.1097/PCC.0000000000000382.
The inclusion of dexmedetomidine in the operative and postoperative management of infants with congenital heart defects has lessened the need for opioids that may cause respiratory depression. Our objective was to show that a dexmedetomidine bolus at or about the time of sternal closure is associated with a decrease in the use of mechanical ventilation in the immediate postoperative period.
Retrospective cohort study.
Single pediatric tertiary cardiac center.
Infants undergoing surgical intervention for congenital heart defects requiring cardiopulmonary bypass, age 30-365 days in a 5-year time period from June 1, 2008, to December 31, 2012.
None.
Of 1,057 total encounters, 441 met inclusion criteria and were evenly distributed over the 5-year time period. Dexmedetomidine had been given at or about the time of sternal closure in 57% of patients. When the exposed and unexposed groups were compared in terms of mechanical ventilation immediately postoperative, there was a statistically significant effect of using dexmedetomidine on the odds of receiving mechanical ventilation (p = 0.0019). This difference remained significant after adjusting for covariates affecting the decision for mechanical ventilation, including year of the procedure, age and weight of subject, cardiopulmonary bypass time, the use of deep hypothermic circulatory arrest, intraoperative fentanyl dose, and the Risk Adjustment for Congenital Heart Surgery Score 1 (p = 0.0317). The odds of receiving mechanical ventilation are estimated to be two times higher for patients who did not receive dexmedetomidine than for patients who received dexmedetomidine after adjusting for variables.
The use of dexmedetomidine bolus in the operating room at the time of sternal closure in infants undergoing open heart surgery is associated with reduced need for mechanical ventilation in the immediate postoperative period.
在先天性心脏病婴儿的手术及术后管理中加入右美托咪定，减少了对可能导致呼吸抑制的阿片类药物的需求。我们的目的是表明在胸骨闭合时或大约此时给予右美托咪定推注与术后即刻机械通气使用的减少相关。
回顾性队列研究。
单一儿科三级心脏中心。
2008年6月1日至2012年12月31日这5年期间，年龄30 - 365天、因先天性心脏病需要体外循环而接受手术干预的婴儿。
无。
在总共1057次病例中，441例符合纳入标准且在5年期间均匀分布。57%的患者在胸骨闭合时或大约此时给予了右美托咪定。当比较暴露组和未暴露组术后即刻的机械通气情况时，使用右美托咪定对接受机械通气的几率有统计学显著影响（p = 0.0019）。在调整影响机械通气决策的协变量后，这种差异仍然显著，这些协变量包括手术年份、受试者年龄和体重、体外循环时间、深低温停循环的使用、术中芬太尼剂量以及先天性心脏病手术风险调整评分1（p = 0.0317）。在调整变量后，未接受右美托咪定的患者接受机械通气的几率估计是接受右美托咪定患者的两倍。
在接受心脏直视手术的婴儿胸骨闭合时在手术室使用右美托咪定推注与术后即刻机械通气需求的减少相关。
Zotero 插件