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危重症儿科患者的镇痛与镇静:近期指南更新及观点

Analgesia and sedation in critically ill pediatric patients: an update from the recent guidelines and point of view.

作者信息

Mondardini Maria Cristina, Sperotto Francesca, Daverio Marco, Amigoni Angela

机构信息

Pediatric Anesthesia and Intensive Care Unit, Department of Woman's and Child's Health, IRCCS University Hospital of Bologna Policlinico S. Orsola, Bologna, Italy.

Cardiovascular Critical Care Unit, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

出版信息

Eur J Pediatr. 2023 May;182(5):2013-2026. doi: 10.1007/s00431-023-04905-5. Epub 2023 Mar 9.

Abstract

In the last decades, the advancement of knowledge in analgesia and sedation for critically ill pediatric patients has been conspicuous and relevant. Many recommendations have changed to ensure patients' comfort during their intensive care unit (ICU) stay and prevent and treat sedation-related complications, as well as improve functional recovery and clinical outcomes. The key aspects of the analgosedation management in pediatrics have been recently reviewed in two consensus-based documents. However, there remains a lot to be researched and understood. With this narrative review and authors' point of view, we aimed to summarize the new insights presented in these two documents to facilitate their interpretation and application in clinical practice, as well as to outline research priorities in the field.    Conclusion: With this narrative review and authors' point of view, we aimed to summarize the new insights presented in these two documents to facilitate their interpretation and application in clinical practice, as well as to outline research priorities in the field. What is Known: • Critically ill pediatric patients receiving intensive care required analgesia and sedation to attenuate painful and stressful stimuli. •Optimal management of analgosedation is a challenge often burdened with complications such as tolerance, iatrogenic withdrawal syndrome, delirium, and possible adverse outcomes. What is New: •The new insights on the analgosedation treatment for critically ill pediatric patients delineated in the recent guidelines are summarized to identify strategies for changes in clinical practice. •Research gaps and potential for quality improvement projects are also highlighted.

摘要

在过去几十年中,危重症儿科患者镇痛和镇静方面的知识进展显著且意义重大。许多建议已经改变,以确保患者在重症监护病房(ICU)住院期间的舒适度,预防和治疗与镇静相关的并发症,并改善功能恢复和临床结局。儿科镇痛镇静管理的关键方面最近在两份基于共识的文件中进行了综述。然而,仍有许多有待研究和了解的地方。通过这篇叙述性综述和作者的观点,我们旨在总结这两份文件中提出的新见解,以促进其在临床实践中的解释和应用,并概述该领域的研究重点。结论:通过这篇叙述性综述和作者的观点,我们旨在总结这两份文件中提出的新见解,以促进其在临床实践中的解释和应用,并概述该领域的研究重点。已知信息:•接受重症监护的危重症儿科患者需要镇痛和镇静以减轻疼痛和应激刺激。•镇痛镇静的最佳管理是一项挑战,常伴有耐受性、医源性戒断综合征、谵妄以及可能的不良后果等并发症。新内容:•总结了近期指南中关于危重症儿科患者镇痛镇静治疗的新见解,以确定临床实践变革的策略。•还强调了研究差距和质量改进项目的潜力。

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