Natale JoAnne E, Asaro Lisa A, Joseph Jill G, Ulysse Christine, Ascenzi Judith, Bowens Cindy, Wypij David, Curley Martha A Q
Department of Pediatrics, University of California, Davis, Sacramento, California.
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
Ann Am Thorac Soc. 2021 Jan;18(1):93-102. doi: 10.1513/AnnalsATS.201912-872OC.
Racial disparities in pain management have been previously reported for children receiving emergency care. To determine whether patient race or ethnicity is associated with the broader goal of pain management and sedation among pediatric patients mechanically ventilated for acute respiratory failure. Planned secondary analysis of RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure). RESTORE, a cluster-randomized clinical trial conducted in 31 U.S. pediatric intensive care units, compared protocolized sedation management (intervention arm) with usual care (control arm). Participants included 2,271 children identified as non-Hispanic white (white, = 1,233), non-Hispanic Black (Black, = 502), or Hispanic of any race (Hispanic, = 536). Within each treatment arm, neither opioid nor benzodiazepine selection, nor cumulative dosing, differed significantly among race and ethnicity groups. Black patients experienced fewer days with an episode of pain (compared with white patients in the control arm and with Hispanic patients in the intervention arm) and experienced less iatrogenic withdrawal syndrome (compared with white patients in either arm or with Hispanic patients in the intervention arm). The percentage of days awake and calm while intubated was not significantly different in pairwise comparisons by race and ethnicity groups in either the control arm (median: white, 75%; Black, 71%; Hispanic, 75%) or the intervention arm (white, 86%; Black, 88%; Hispanic, 85%). Across multiple measures, our study found scattered differences in sedation management among critically ill Black, Hispanic, and white children that did not consistently favor any group. However, racial disparities related to implicit bias cannot be completely ruled out.Clinical trial registered with clinicaltrials.gov (NCT00814099).
先前已有报告称，接受急诊治疗的儿童在疼痛管理方面存在种族差异。本研究旨在确定患者的种族或族裔是否与因急性呼吸衰竭接受机械通气的儿科患者疼痛管理和镇静这一更广泛目标相关。对RESTORE（呼吸衰竭镇静滴定随机评估）进行计划中的二次分析。RESTORE是一项在美国31个儿科重症监护病房进行的整群随机临床试验，将标准化镇静管理（干预组）与常规护理（对照组）进行了比较。参与者包括2271名儿童，分别被确定为非西班牙裔白人（白人，n = 1233）、非西班牙裔黑人（黑人，n = 502）或任何种族的西班牙裔（西班牙裔，n = 536）。在每个治疗组中，种族和族裔群体之间在阿片类药物或苯二氮䓬类药物的选择以及累积剂量方面均无显著差异。黑人患者疼痛发作的天数较少（与对照组中的白人患者以及干预组中的西班牙裔患者相比），且医源性戒断综合征的发生率较低（与任一治疗组中的白人患者以及干预组中的西班牙裔患者相比）。在对照组（中位数：白人，75%；黑人，71%；西班牙裔，75%）或干预组（白人，86%；黑人，88%；西班牙裔，85%）中，按种族和族裔群体进行的两两比较中，插管期间清醒且平静的天数百分比无显著差异。在多项指标中，我们的研究发现，重症黑人、西班牙裔和白人儿童在镇静管理方面存在零散差异，这些差异并不总是对任何一个群体有利。然而，与隐性偏见相关的种族差异不能完全排除。本临床试验已在clinicaltrials.gov注册（NCT00814099）。
