Department of Pediatrics, Shengjing Hospital of China Medical University, No.36, San Hao Street, Heping District, Shenyang, LiaoNing Province, China.
Department of Nerve Function, Shengjing Hospital of China Medical University, Shenyang, China.
BMC Pediatr. 2022 Oct 12;22(1):589. doi: 10.1186/s12887-022-03658-8.
To investigate the characteristics of sleep cycle in children with severe acute bronchopneumonia treated with invasive mechanical ventilation at different sedation depths.
We included 35 pediatric patients with severe acute bronchopneumonia treated using mechanical ventilation in Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University. They were divided into deep sedation group (n = 21; ramsay score 5-6) and light sedation group (n = 14; ramsay score3-4) based on sedation depth achieved during mechanical ventilation. Long-term video electroencephalography (EEG) monitoring was performed within the first 24 h after starting mechanical ventilation and after weaning from mechanical ventilation and discontinuing sedatives and analgesics. The results were analyzed and compared with those of normal children to analyze changes in sleep cycle characteristics at different sedation depths and mechanical ventilation stages.
There were 29 cases altered sleep architecture. The deep sedation group had a significantly higher incidence of sleep architecture altered, total sleep duration, and non-rapid eye movement sleep-1 (NREM-1) loss incidence than the light sedation group. Moreover, the deep sedation group had a significantly lower awakening number and rapid eye movement sleep (REM) percentage than the light sedation group. The sleep cycle returned to normal in 27 (77%) patients without NREM-1 or REM sleep loss.
Deep sedation during mechanical ventilation allows longer total sleep duration, fewer awakenings, and an increased deep sleep proportion, but sleep architecture is severely altered. After weaning from mechanical ventilation and sedative discontinuation, lightly sedated children exhibit better sleep recovery.
研究不同镇静深度下接受有创机械通气治疗的严重急性支气管肺炎儿童睡眠周期的特征。
我们纳入了中国医科大学附属盛京医院儿科重症监护病房 35 例接受机械通气治疗的严重急性支气管肺炎患儿。根据机械通气期间达到的镇静深度，将其分为深度镇静组（n = 21； Ramsay 评分 5-6）和浅镇静组（n = 14； Ramsay 评分 3-4）。在开始机械通气后 24 小时内和机械通气脱机及停止镇静和镇痛后进行长期视频脑电图（EEG）监测。分析结果并与正常儿童进行比较，以分析不同镇静深度和机械通气阶段睡眠周期特征的变化。
共有 29 例患儿睡眠结构改变。深度镇静组睡眠结构改变、总睡眠时间和非快速眼动睡眠-1（NREM-1）丢失发生率显著高于浅镇静组。此外，深度镇静组觉醒次数和快速眼动睡眠（REM）百分比显著低于浅镇静组。27 例（77%）患儿无 NREM-1 或 REM 睡眠丢失，睡眠周期恢复正常。
机械通气期间深度镇静可延长总睡眠时间、减少觉醒次数、增加深睡眠比例，但睡眠结构严重改变。机械通气脱机和镇静剂停药后，浅镇静患儿睡眠恢复更好。
