Taffarel Pedro, Bonetto German, Jorro Barón Facundo, Meregalli Claudia
Servicio de Terapia Intensiva del Hospital General de Niños Dr. Pedro de Elizalde (HGNPE), Ciudad Autónoma de Buenos Aires, Argentina.
Servicio de Terapia Intensiva del Sanatorio Sagrado Corazón, Ciudad Autónoma de Buenos Aires, Argentina.
Arch Argent Pediatr. 2018 Apr 1;116(2):e196-e203. doi: 10.5546/aap.2018.eng.e196.
Children in pediatric intensive care units (PICUs) are exposed to experiencing pain, stress and anxiety due to their disease, treatment or care setting. Adequate sedation and analgesia are key to their care, particularly in patients requiring mechanical ventilation (MV).
To determine the usual practice in sedation and analgesia management in patients requiring MV in PICUs in Argentina.
Descriptive, crosssectional, multi-center study conducted by means of e-mailed surveys.
A total of 45 PICUs were surveyed, 18% (N= 8) of which follow a sedation and analgesia protocol strictly, while 58% (N= 26) follow an "implied" protocol based on routine practice. The most commonly used drugs were midazolam, for sedation, and fentanyl, for analgesia. In 31% (N= 14) of the PICUs, sedation was monitored through assessment scales (modified Ramsay and/or Comfort scales). In 4% (N= 2) of units, daily, scheduled interruptions of sedation was implemented. In patients who are difficult to sedate, dexmedetomidine was the most commonly used adjuvant. In 73% (N= 33) of the units, neuromuscular blocking agents were used in compliance with precise guidelines and under clinical monitoring. In 20% (N= 9) of the PICUs there was a sedation and analgesia weaning protocol in place, and morphine and lorazepam are the most commonly used drugs.
Only a low percentage of surveyed PICUs had a protocol in place for the routine management of sedation and analgesia in patients on MV.
儿科重症监护病房（PICU）的儿童因疾病、治疗或护理环境而面临疼痛、压力和焦虑。充分的镇静和镇痛是其护理的关键，尤其是对于需要机械通气（MV）的患者。
确定阿根廷PICU中需要MV的患者在镇静和镇痛管理方面的常规做法。
通过电子邮件调查进行描述性、横断面、多中心研究。
共调查了45个PICU，其中18%（N = 8）严格遵循镇静和镇痛方案，而58%（N = 26）遵循基于常规做法的“隐含”方案。最常用的药物是用于镇静的咪达唑仑和用于镇痛的芬太尼。在31%（N = 14）的PICU中，通过评估量表（改良Ramsay量表和/或Comfort量表）监测镇静情况。在4%（N = 2）的科室中，实施了每日定时中断镇静。对于难以镇静的患者，右美托咪定是最常用的辅助药物。在73%（N = 33）的科室中，按照精确指南并在临床监测下使用神经肌肉阻滞剂。在20%（N = 9）的PICU中有镇静和镇痛撤药方案，吗啡和劳拉西泮是最常用的药物。
在接受调查的PICU中，只有一小部分制定了针对MV患者镇静和镇痛常规管理的方案。
