Department of Pediatric Cardiology, Pulmonology, and, Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany.
Department of Thoracic, Cardiac, and Vascular Surgery, University Hospital, Tübingen, Tübingen, Germany.
J Spec Pediatr Nurs. 2020 Jul;25(3):e12291. doi: 10.1111/jspn.12291. Epub 2020 Apr 3.
Analgesia and sedation protocols are reported to reduce the requirement of sedative and analgesic agents, duration of mechanical ventilation, and length of pediatric intensive care unit (PICU) stay. However, these studies often were conducted based on inhomogeneous cohorts. The aim of this study was the evaluation of a nurse-driven analgesia and sedation protocol in a homogenous population of infants following corrective surgery for tetralogy of Fallot (TOF).
This retrospective analysis was conducted in a cardiac PICU of a tertiary referral center. Two cohorts of patients who underwent corrective surgery for TOF below the age of 7 months, were retrospectively evaluated before and after implementation of a nurse-driven analgesia and sedation protocol. We compared peak and cumulative doses of midazolam, morphine, and clonidine, length of PICU stay and time on mechanical ventilation.
A total of 33 patients were included in the preimplementation period and 32 during the postimplementation period. Implementation of the nurse-driven analgesia and sedation protocol had no effect on time on mechanical ventilation (72 hr [24-141] vs. 49 hr [24-98]), but significantly on length of PICU stay (7 days [5-14] vs. 5 days [4-7]). Cumulative doses of midazolam (7.37 mg/kg [4.70-17.65] vs. 5.0 mg/kg [2.70-9.12]) as well as peak doses of midazolam (0.22 mg·kg ·hr [0.20-0.33] vs. 0.15 mg·kg ·hr [0.13-0.20]) and morphine (50.0 µg·kg ·hr [39.7-79.9] vs. 42.5 µg·kg ·hr [29.7-51.8]) were significantly reduced. The postimplemantation group showed no increase in postoperative complications and adverse events.
The implementation of a nurse-driven analgesia and sedation protocol is safe in infants following corrective surgery for TOF. It reduces significantly the length of PICU stay, cumulative and peak doses of midazolam and peak doses of morphine.
据报道，镇痛和镇静方案可减少镇静和镇痛药物的需求、机械通气时间和儿科重症监护病房（PICU）的住院时间。然而，这些研究通常基于异质队列进行。本研究的目的是评估一种基于护士主导的镇痛和镇静方案在接受法洛四联症（TOF）矫正手术的同质婴儿人群中的效果。
这是一项在三级转诊中心的心脏 PICU 进行的回顾性分析。回顾性评估了在实施基于护士主导的镇痛和镇静方案前后，接受 TOF 矫正手术且年龄均小于 7 个月的两组患者。我们比较了咪达唑仑、吗啡和可乐定的峰和累积剂量、PICU 住院时间和机械通气时间。
共纳入 33 例患者在实施前，32 例患者在实施后。实施基于护士主导的镇痛和镇静方案对机械通气时间（72 小时[24-141]与 49 小时[24-98]）无影响，但对 PICU 住院时间（7 天[5-14]与 5 天[4-7]）有显著影响。咪达唑仑的累积剂量（7.37mg/kg[4.70-17.65]与 5.0mg/kg[2.70-9.12]）以及咪达唑仑（0.22mg·kg·hr[0.20-0.33]与 0.15mg·kg·hr[0.13-0.20]）和吗啡（50.0μg·kg·hr[39.7-79.9]与 42.5μg·kg·hr[29.7-51.8]）的峰剂量显著降低。实施后组无术后并发症和不良事件增加。
在接受 TOF 矫正手术的婴儿中实施基于护士主导的镇痛和镇静方案是安全的。它显著降低了 PICU 住院时间、咪达唑仑的累积和峰剂量以及吗啡的峰剂量。
