Torres Soblechero Laura, Ocampo Benegas Doris Elena, Manrique Martín Gema, Butragueño Laiseca Laura, Leal Barceló Andrea María, Parreño Marchante Alejandro, López-Herce Cid Jesús, Mencía Bartolome Santiago
Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
An Pediatr (Engl Ed). 2023 Apr;98(4):276-282. doi: 10.1016/j.anpede.2023.02.014. Epub 2023 Mar 14.
Analgesia and sedation are a priority in paediatric intensive care. The combination of ketamine and propofol is a possible option in patients requiring prolonged or difficult sedation and to reduce the use of benzodiazepines and opiates. The aim of this study was to assess the efficacy and safety of combination ketamine and propofol in continuous infusion for prolonged analgesia/sedation in the paediatric intensive care setting.
Prospective, observational single-group cohort study in patients aged 1 month to 16 years admitted to the paediatric intensive care unit in 2016-2018 that received ketamine and propofol in continuous infusion for analgesia and sedation. We collected data on demographic and clinical characteristics, analgesia and sedation scores (MAPS, COMFORT-B and SOPHIA), haemodynamic parameters and adverse events.
The study included 32 patients. The maximum dose of ketamine was 1.5 mg/kg/h (interquartile range [IQR], 1-2 mg/kg/h) and the infusion duration was 5 days (IQR, 3-5 days). The maximum dose of propofol was 3.2 mg/kg/h (IQR, 2.5-3.6 mg/kg/h) and the infusion duration, 5 days (IQR, 3-5 days). Thirty (93.7%) patients had previously received midazolam and 29 (90.6%) fentanyl. Analgesia scores did not change after initiation of the ketamine and propofol infusion. There was a statistically significant increase in the COMFORT-B score, but the score remained in the adequate sedation range (12-17). There were small but statistically significant decreases in the mean arterial pressure (from 64 mmHg to 60 mmHg; P = .006) and the diastolic blood pressure (from 50.5 to 48 mmHg; P = .023) 1 h after the initiation of the ketamine and propofol infusion, but this difference was not observed 12 h later and did not require administration of vasoactive drugs. No other major adverse events were detected during the infusion.
The combination of ketamine and propofol in continuous infusion is a safe treatment in critically ill children that makes it possible to achieve an appropriate level of analgesia and sedation without relevant haemodynamic repercussions.
镇痛和镇静是儿科重症监护中的首要任务。氯胺酮和丙泊酚联合使用是需要长时间或困难镇静的患者以及减少苯二氮䓬类药物和阿片类药物使用的一种可能选择。本研究的目的是评估氯胺酮和丙泊酚联合持续输注在儿科重症监护环境中用于长时间镇痛/镇静的有效性和安全性。
对2016 - 2018年入住儿科重症监护病房、年龄在1个月至16岁、接受氯胺酮和丙泊酚持续输注进行镇痛和镇静的患者进行前瞻性、观察性单组队列研究。我们收集了人口统计学和临床特征、镇痛和镇静评分（MAPS、COMFORT - B和SOPHIA）、血流动力学参数及不良事件的数据。
该研究纳入32例患者。氯胺酮最大剂量为1.5mg/kg/h（四分位间距[IQR]，1 - 2mg/kg/h），输注持续时间为5天（IQR，3 - 5天）。丙泊酚最大剂量为3.2mg/kg/h（IQR，2.5 - 3.6mg/kg/h），输注持续时间为5天（IQR，3 - 5天）。30例（93.7%）患者此前接受过咪达唑仑，29例（90.6%）接受过芬太尼。氯胺酮和丙泊酚输注开始后镇痛评分未改变。COMFORT - B评分有统计学意义的升高，但仍处于适当镇静范围（12 - 17）。氯胺酮和丙泊酚输注开始1小时后平均动脉压（从64mmHg降至60mmHg；P = 0.006）和舒张压（从50.5降至48mmHg；P = 0.023）有小幅但统计学意义的下降，但12小时后未观察到这种差异，且无需使用血管活性药物。输注期间未检测到其他重大不良事件。
氯胺酮和丙泊酚联合持续输注对危重症儿童是一种安全的治疗方法，能够在不产生相关血流动力学影响的情况下达到适当的镇痛和镇静水平。
