Department of Intensive Care, Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina.
Department of Quality, Patient Safety, and Clinical Management, Institute of Clinical and Health Effectiveness, City of Buenos Aires, Argentina
Arch Argent Pediatr. 2023 Aug 1;121(4):e202202806. doi: 10.5546/aap.2022-02806.eng. Epub 2023 Jan 26.
Introduction. Adequate sedation and analgesia is essential in the management of patients requiring mechanical ventilation (MV). The implementation of protocols and their monitoring is recommended; mixed results on adherence and impact have been reported. Objectives. To assess the impact of the implementation of a sedation and analgesia protocol on the use of benzodiazepines, opioids, and evolution in the pediatric intensive care unit (PICU) in patients requiring MV for more than 72 hours. Methods. Before-and-after, uncontrolled study in the PICU of a children’s hospital. The study was developed in 3 stages: pre-intervention for situational diagnosis (from April to September 2019), intervention,and post-intervention for implementation of a sedation and analgesia protocol, education on use, and monitoring of adherence and impact (from October 2019 to October 2021). Results. A total of 99 and 92 patients were included in the study in the pre- and post-intervention stages, respectively. Patients had a more severe condition, were younger, and had a lower weight in the preintervention period. After adjusting for severity and age, the group comparison in the post-intervention stage showed a reduction in days of continuous infusion of opioids (6 ± 5.2 versus 7.6–5.8, p = 0.018) and days of continuous infusion of benzodiazepines (3.3 ± 3.5 versus 7.6 ± 6.8, p = 0.001). No significantdifferences were observed in days of MV and total days of benzodiazepine use. Conclusion. The implementation of a sedation and analgesia protocol resulted in a reduction in the use of continuous infusion of drugs.
引言。对于需要机械通气（MV）的患者，充分的镇静和镇痛是至关重要的。建议实施方案并进行监测，但关于依从性和影响的结果存在差异。目的。评估镇静和镇痛方案的实施对需要 MV 超过 72 小时的患者在儿科重症监护病房（PICU）中使用苯二氮䓬类药物、阿片类药物和病情变化的影响。方法。这是一项在儿童医院 PICU 进行的前后对照、非对照研究。该研究分为 3 个阶段进行：干预前的现状诊断阶段（2019 年 4 月至 9 月）、干预阶段和实施镇静和镇痛方案、使用教育以及监测依从性和影响的干预后阶段（2019 年 10 月至 2021 年 10 月）。结果。干预前和干预后阶段分别有 99 例和 92 例患者纳入研究。干预前患者的病情更严重、年龄更小、体重更轻。在调整了严重程度和年龄后，干预后阶段的组间比较显示，连续输注阿片类药物的天数（6 ± 5.2 与 7.6–5.8，p = 0.018）和连续输注苯二氮䓬类药物的天数（3.3 ± 3.5 与 7.6 ± 6.8，p = 0.001）均减少。MV 天数和苯二氮䓬类药物总使用天数无显著差异。结论。镇静和镇痛方案的实施导致连续输注药物的使用减少。
