Zuppa Athena F, Curley Martha A Q
Department of Pediatric Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Center for Clinical Pharmacology, Colket Translational Research, Room 4008, 3614 Civic Center Boulevard, Philadelphia, PA 19104-4318, USA.
Anesthesia and Critical Care Medicine, School of Nursing, University of Pennsylvania, Claire M. Fagin Hall, 418 Curie Boulevard - #425, Philadelphia, PA 19104-4217, USA.
Pediatr Clin North Am. 2017 Oct;64(5):1103-1116. doi: 10.1016/j.pcl.2017.06.013. Epub 2017 Aug 18.
Sedation is a mainstay of therapy for critically ill children. Although necessary in the care of the critically ill child, sedative drugs are associated with adverse effects, such as disruption of circadian rhythm, altered sleep, delirium, potential neurotoxicity, and immunosuppression. Optimal approaches to the sedation of the critically ill child should include identification of sedation targets and sedation interruptions, allowing for a more individualized approach to sedation. Further research is needed to better understand the relationship between critical illness and sedation pharmacokinetics and pharmacodynamics, the impact of sedation on immune function, and the genetic implications on drug disposition and response.
镇静是危重症儿童治疗的主要手段。尽管在危重症儿童护理中是必要的,但镇静药物会带来不良反应,如昼夜节律紊乱、睡眠改变、谵妄、潜在神经毒性和免疫抑制。危重症儿童镇静的最佳方法应包括确定镇静目标和中断镇静,从而实现更个体化的镇静方法。需要进一步研究以更好地理解危重症与镇静药代动力学和药效学之间的关系、镇静对免疫功能的影响以及药物处置和反应的遗传学意义。