Hospital de Clínicas de Porto Alegre, Pediatric Intensive Care Unit - Porto Alegre (RS), Brazil.
McGill University, Department of Pediatrics, Division of Pediatric Critical Care - Montreal (QC), Canada.
Rev Assoc Med Bras (1992). 2022 Jul;68(7):xxx. doi: 10.1590/1806-9282.20220166.
This study aimed to assess the clonidine infusion rate in the first 6 h, as maintenance dose (first 24 h), and in the pre-extubation period (last 24 h), as well as the cumulative dose of other sedatives and the hemodynamic response.
This is a retrospective cohort study.
Children up to the age of 2 years who were admitted to the pediatric intensive care unit of a tertiary referral hospital in the south region of Brazil, between January 2017 and December 2018, were submitted to mechanical ventilation, and received continuous clonidine infusions were included in the study. The initial, maintenance, and pre-extubation doses of clonidine; the vasoactive-inotropic score; heart rate; and systolic and diastolic blood pressure of the study participants were assessed. A total of 66 patients with a median age of 4 months who were receiving clonidine infusions were included. The main indications for mechanical ventilation were acute viral bronchiolitis (56%) and pneumonia associated with acute respiratory distress syndrome (15%). The median of clonidine infusion in the first 6 h (66 patients) was 0.53 μg/kg/h (IQR 0.49-0.88), followed by 0.85 μg/kg/h (IQR 0.53-1.03) during maintenance (57 patients) and 0.63 μg/kg/h (IQR 0.54-1.01) during extubation period (42 patients) (p=0.03). No differences were observed in the doses regarding the indication for mechanical ventilation. Clonidine infusion was not associated with hemodynamic changes and showed no differences when associated with adjuvants.
Clonidine demonstrated to be a well-tolerated sedation option in pediatric patients submitted to mechanical ventilation, without relevant influence in hemodynamic variables.
本研究旨在评估氯胺酮在最初 6 小时的输注率（维持剂量，即前 24 小时）、前拔管期（最后 24 小时）的输注率，以及其他镇静剂的累积剂量和血流动力学反应。
这是一项回顾性队列研究。
2017 年 1 月至 2018 年 12 月，巴西南部地区的一家三级转诊医院的儿科重症监护病房收治的年龄在 2 岁以下的儿童接受了机械通气，并接受了持续氯胺酮输注，这些儿童被纳入本研究。评估了研究参与者的氯胺酮初始剂量、维持剂量和前拔管期剂量；血管活性-正性肌力评分；心率；以及收缩压和舒张压。共纳入了 66 例中位年龄为 4 个月且接受氯胺酮输注的患者。机械通气的主要指征是急性病毒性细支气管炎（56%）和急性呼吸窘迫综合征相关肺炎（15%）。前 6 小时氯胺酮输注的中位数（66 例）为 0.53μg/kg/h（IQR 0.49-0.88），随后在维持期（57 例）的中位数为 0.85μg/kg/h（IQR 0.53-1.03），在拔管期（42 例）的中位数为 0.63μg/kg/h（IQR 0.54-1.01）（p=0.03）。机械通气的指征不同，但剂量没有差异。氯胺酮输注与血流动力学变化无关，与辅助药物联合使用时也没有差异。
氯胺酮在接受机械通气的儿科患者中是一种耐受性良好的镇静选择，对血流动力学变量没有明显影响。
