危重症儿童右美托咪定当前使用情况及戒断症状管理的调查
Survey of the Current Use of Dexmedetomidine and Management of Withdrawal Symptoms in Critically Ill Children.
作者信息
Thompson R Zachary, Gardner Brian M, Autry Elizabeth B, Day Scottie B, Krishna Ashwin S
出版信息
J Pediatr Pharmacol Ther. 2019 Jan-Feb;24(1):16-21. doi: 10.5863/1551-6776-24.1.16.
OBJECTIVES
Dexmedetomidine use for sedation in the pediatric intensive care units (PICUs) has increased since its initial US Food and Drug Administration (FDA) approval in adults. However, there is limited evidence to direct providers regarding current usage, dosing, and monitoring for withdrawal symptoms in pediatric patients. This study sought to determine the utilization of dexmedetomidine and management of dexmedetomidine withdrawal symptoms among PICU physicians.
METHODS
A questionnaire survey was distributed to all members of the American Academy of Pediatrics Section on Critical Care. It assessed the practice site demographics, indication, dosing, and duration of dexmedetomidine infusion, unit protocol, and strategies for management of dexmedetomidine withdrawal.
RESULTS
A total of 147 surveys (21.1%) were returned and analyzed. The reported uses for dexmedetomidine were as a primary sedative (59.9%), adjunctive agent for sedation (82.3%), and adjunctive agent to assist weaning sedation (62.6%) or from mechanical ventilation (70.1%). One hundred twenty-nine respondents (87.8%) had concerns over dexmedetomidine withdrawal, with 59 respondents becoming concerned after 120 hours of infusion (45.7%). Most respondents reported managing dexmedetomidine withdrawal symptoms via a regimented wean and initiation of clonidine (81%). Units with >1000 admissions per year were more likely to have a protocol related to dexmedetomidine use (p = 0.021). Units with >1000 admissions per year reported using clonidine for withdrawal at a higher rate, whereas units with ≤1000 admissions per year used a systematic wean of dexmedetomidine (p = 0.014).
CONCLUSIONS
Dexmedetomidine use in the PICU is varied among pediatric intensive care physicians. Intensivists have withdrawal concerns after dexmedetomidine discontinuation, and the primary management of this withdrawal phenomenon is the initiation of clonidine with a regimented dexmedetomidine wean.
目的
自右美托咪定最初获得美国食品药品监督管理局（FDA）批准用于成人镇静以来，其在儿科重症监护病房（PICU）的使用有所增加。然而，关于儿科患者当前使用情况、给药剂量以及戒断症状监测方面，可供医护人员参考的证据有限。本研究旨在确定PICU医生对右美托咪定的使用情况以及右美托咪定戒断症状的处理方式。
方法
向美国儿科学会危重症医学分会的所有成员发放了一份问卷调查。该问卷评估了执业地点的人口统计学特征、右美托咪定输注的适应症、给药剂量和持续时间、科室方案以及右美托咪定戒断症状的处理策略。
结果
共收回并分析了147份调查问卷（回收率为21.1%）。右美托咪定的报告用途包括作为主要镇静剂（59.9%）、辅助镇静剂（82.3%）以及辅助撤机镇静剂（62.6%）或辅助脱离机械通气（70.1%）。129名受访者（87.8%）对右美托咪定戒断表示担忧，其中59名受访者在输注120小时后开始担忧（45.7%）。大多数受访者报告通过有计划的撤药和开始使用可乐定来处理右美托咪定戒断症状（81%）。每年收治超过1000例患者的科室更有可能有与右美托咪定使用相关的方案（p = 0.021）。每年收治超过1000例患者的科室报告使用可乐定进行戒断处理的比例更高，而每年收治≤1000例患者的科室则采用有计划的右美托咪定撤药方式（p = 0.014）。
结论
儿科重症监护医生在PICU中使用右美托咪定的情况各不相同。重症监护医生在停用右美托咪定后会担心戒断问题，而这种戒断现象的主要处理方法是开始使用可乐定并进行有计划的右美托咪定撤药。
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