Szemere Ambrus, Fazekas Alíz, Sebestyén Anna Réka, Ezzeddine Rani, Upor Veronika, Engh Marie Anne, Hegyi Péter, Molnár Zsolt, Horváth Klára
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
Clin Exp Pediatr. 2025 Jun;68(6):406-416. doi: 10.3345/cep.2024.01711. Epub 2025 Feb 19.
This study aimed to evaluate the effectiveness and safety of protocolized sedation in mechanically ventilated pediatric intensive care unit (PICU) patients. A comprehensive search was conducted in MEDLINE, CENTRAL, Embase, Web of Science, and Scopus from inception to October 18, 2023. Randomized controlled trials (RCTs) and observational studies that compared protocol-directed sedation management with conventional sedation regimens in pediatric patients who required invasive mechanical ventilation (IMV) for >24 hours were included. Twenty-six studies (15,214 participants) were included. We found a statistically significant reduction in IMV duration (median difference [MD]=-13.88 hours; 95% confidence interval [CI], -25.46 to -2.29; P=0.022), PICU length of stay (MD=-0.64 days; 95% CI, -1.26 to -0.02; P=0.045). We found significant reductions in the duration (MD=-1.28 days; 95% CI, -2.26 to -0.31; P=0.016) and peak dose (MD=-0.05 mg/kg/hr 95% CI, -0.11 to 0.002; P=0.044) of benzodiazepines. A significant increase was found in the odds of unplanned extubation (odds ratio, 1.13; 95% CI, 1.02 to 1.26; P=0.029). We found no significant results regarding the other outcomes. Our results suggest that protocolized sedation may reduce ventilation requirements and PICU length of stay; however, these findings were not confirmed by RCTs. Moreover, we observed a trend toward a reduction in sedative exposure and an increased odds of unplanned extubation.
本研究旨在评估在机械通气的儿科重症监护病房（PICU）患者中实施规范化镇静的有效性和安全性。从数据库建库至2023年10月18日，我们在MEDLINE、CENTRAL、Embase、Web of Science和Scopus中进行了全面检索。纳入了比较规范化镇静管理与传统镇静方案的随机对照试验（RCT）和观察性研究，这些研究的对象为需要有创机械通气（IMV）超过24小时的儿科患者。共纳入26项研究（15214名参与者）。我们发现，IMV持续时间有统计学显著缩短（中位数差异[MD]=-13.88小时；95%置信区间[CI]，-25.46至-2.29；P=0.022），PICU住院时间也显著缩短（MD=-0.64天；95%CI，-1.26至-0.02；P=0.045）。我们发现苯二氮䓬类药物的使用持续时间（MD=-1.28天；95%CI，-2.26至-0.31；P=0.016）和峰值剂量（MD=-0.05mg/kg/小时；95%CI，-0.11至0.002；P=0.044）均显著降低。非计划拔管的几率显著增加（优势比，1.13；95%CI，1.02至1.26；P=0.029）。我们在其他结局方面未发现显著结果。我们的结果表明，规范化镇静可能会减少通气需求和PICU住院时间；然而，这些发现未得到RCT的证实。此外，我们观察到镇静药物暴露有减少的趋势，且非计划拔管的几率增加。
