Division of Pediatric Critical Care Medicine,
Departments of Pediatrics and.
Pediatrics. 2020 May;145(5). doi: 10.1542/peds.2019-3559.
Pediatric subspecialists routinely provide procedural sedation outside the operating room. No large study has reported trends in outpatient pediatric procedural sedation. Our purpose in this study was to identify significant trends in outpatient procedural sedation using the Pediatric Sedation Research Consortium.
Prospectively collected data from 2007 to 2018 were used for trending procedural sedation. Patient characteristics, medications, type of providers, serious adverse events, and interventions were reported. The Cochran-Armitage test for trend was used to explore the association between the year and a given characteristic.
A total of 432 842 sedation encounters were identified and divided into 3 4-year epochs (2007-2011, 2011-2014, and 2014-2018). There was a significant decrease in infants <3 months of age receiving procedural sedation (odds ratio = 0.97; 95% confidence interval, 0.96-0.98). A large increase was noticed in pediatric hospitalists providing procedural sedation (0.6%-9.5%; < .001); there was a decreasing trend in sedation by other providers who were not in emergency medicine, critical care, or anesthesiology (13.9%-3.9%; < .001). There was an increasing trend in the use of dexmedetomidine (6.3%-9.3%; < .001) and a decreasing trend in the use of chloral hydrate (6.3%-0.01%; < .001) and pentobarbital (7.3%-0.5%; < .001). Serious adverse events showed a nonsignificant increase overall (1.35%-1.75%).
We report an increase in pediatric hospitalists providing sedation and a significant decrease in the use of chloral hydrate and pentobarbital by providers. Further studies are required to see if sedation services decrease costs and optimize resource use.
儿科专家经常在手术室外提供程序镇静。没有大型研究报告门诊儿科程序镇静的趋势。我们在这项研究中的目的是使用儿科镇静研究联盟确定门诊程序镇静的显著趋势。
使用前瞻性收集的 2007 年至 2018 年的数据进行程序镇静趋势分析。报告了患者特征、药物、提供者类型、严重不良事件和干预措施。Cochran-Armitage 趋势检验用于探索年份与特定特征之间的关联。
共确定了 432842 次镇静治疗，并分为 3 个 4 年的时期（2007-2011 年、2011-2014 年和 2014-2018 年）。接受程序镇静治疗的 <3 个月大的婴儿数量显著减少（优势比=0.97；95%置信区间，0.96-0.98）。儿科医院医师提供程序镇静的比例大幅增加（0.6%-9.5%；<.001）；非急诊医学、重症监护或麻醉学的其他提供者提供镇静治疗的趋势呈下降趋势（13.9%-3.9%；<.001）。右美托咪定的使用率呈上升趋势（6.3%-9.3%；<.001），氯醛的使用率呈下降趋势（6.3%-0.01%；<.001）和戊巴比妥（7.3%-0.5%；<.001）。严重不良事件的总体发生率呈上升趋势（1.35%-1.75%），但无统计学意义。
我们报告称，提供镇静的儿科医院医师数量增加，氯醛和戊巴比妥的使用率由提供者显著下降。需要进一步研究以确定镇静服务是否降低成本并优化资源利用。
