Ekinci Faruk, Yildizdas Dincer, Horoz Ozden Ozgur, Aslan Nagehan
Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey.
J Pediatr Intensive Care. 2020 Sep 18;10(4):289-297. doi: 10.1055/s-0040-1716886. eCollection 2021 Nov.
The management and monitoring of sedoanalgesia are important measures in improving the efficacy of procedures and mechanical ventilation, as well as reducing adverse effects and preventing withdrawal syndrome, and delirium in pediatric intensive care units (PICUs). As there is an ongoing need to clarify the best approach to sedoanalgesia in PICUs, we aimed to analyze the current approaches in sedation, analgesia, withdrawal, and delirium practices among PICUs in Turkey. Twenty-seven PICUs completed the survey. Only 9 (33.3%) and 13 (48.1%) centers had a written protocol for analgesia and sedation, respectively. Paracetamol and a combination of midazolam and fentanyl were preferred in 51.8 and 40% of the PICUs for postoperative periods, respectively, and 81.4% of the units preferred ketamine for short-term interventions. For prolonged sedation in mechanically ventilated children, a combination of benzodiazepines and opiates were the most preferred first-line agents with a very high percentage of 81.4%, whereas ketamine and dexmedetomidine accounted for 62.9 and 18.5%, respectively, as second-line options. Although sedative and analgesic agent preferences were comparable with the relevant literature, we should focus on developing a standardized, evidence-based algorithm for sedation and analgesic drugs.
在儿科重症监护病房（PICU）中，镇静镇痛的管理和监测是提高操作及机械通气效果、减少不良反应、预防戒断综合征和谵妄的重要措施。由于持续需要明确PICU中镇静镇痛的最佳方法，我们旨在分析土耳其PICU中目前在镇静、镇痛、戒断及谵妄处理方面的方法。27个PICU完成了调查。分别只有9个（33.3%）和13个（48.1%）中心有镇痛和镇静的书面方案。在术后阶段，分别有51.8%和40%的PICU首选对乙酰氨基酚以及咪达唑仑和芬太尼的组合，81.4%的单位在短期干预中首选氯胺酮。对于机械通气儿童的长期镇静，苯二氮䓬类药物和阿片类药物的组合是最常用的一线药物，占比高达81.4%，而氯胺酮和右美托咪定作为二线选择，分别占62.9%和18.5%。尽管镇静和镇痛药物的选择与相关文献相当，但我们应专注于制定标准化的、基于证据的镇静和镇痛药物算法。
