协议化镇静可以减少儿科重症监护室的通风和镇静要求:系统性审查和元分析
Ambrus Szemere1, Alíz Fazekas2, Anna Réka Sebestyén1,3
1Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Clinical and experimental pediatrics
|February 20, 2025
概括
在儿科重症监护病房 (PICU) 中,协议化镇静可能会缩短机械通风的持续时间和住院时间. 然而,这些发现需要通过随机对照试验 (RCT) 进行确认,并注意到非计划性输出管的增加.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 药理学 药理学是指药理学的学科.
- 基于证据的医学 基于证据的医学
背景情况:
- 镇静管理对于机械通风的儿科患者至关重要.
- 目前的镇静方法各不相同,影响患者的治疗结果.
- 协议化镇静提供了一种结构化的方法来优化护理.
研究的目的:
- 评估在儿科重症监护室 (PICU) 需要侵入性机械通风 (IMV) 的患者中协议化镇静的有效性和安全性.
- 综合来自随机对照试验 (RCT) 和对协议导向镇静与常规疗法的观察性研究的证据.
主要方法:
- 在主要数据库 (MEDLINE,CENTRAL,Embase,Web of Science,Scopus) 进行了系统的文献搜索,截至2023年10月18日.
- 包括的研究比较了儿科患者在24小时以上的IMV中进行协议化镇静与常规方法.
- 分析了26项涉及15214名参与者的研究数据.
主要成果:
- 协议化镇静与IMV持续时间 (MD=13.88小时) 和PICU停留时间 (MD=-0.64天) 的显著减少有关.
- 观察到二甲持续时间 (MD=-1.28天) 和峰值剂量 (MD=-0.05 mg/kg/hr) 显著下降.
- 发现意外输出管的几率显著增加 (OR=1.13) ,但对其他结果没有显著发现.
结论:
- 协议化镇静可以减少通风持续时间和PICU停留时间,但这些好处并没有得到RCT的一致证实.
- 观察到减少镇静剂暴露的趋势.
- 增加非计划性输出管的可能性需要仔细考虑和进一步调查.
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