The Comparison of Cerebral Oxygenation among Mechanically Ventilated Children Receiving Protocolized Sedation and Analgesia versus Clinician’s Decision in Pediatric Intensive Care Unit

IF 1.2 Q3 EMERGENCY MEDICINE
Yogi Prawira, None Irlisnia, Hanifah Oswari, Antonius Hocky Pudjiadi, Bambang Tridjaja Asmara Apri Parwoto, Anggi Gayatri
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Abstract

Abstract Introduction: Adequate sedation and analgesia are two crucial factors affecting recovery of intensive care patients. Improper use of sedation and analgesia in intensive care patients may adversely lead to brain oxygen desaturation. This study aims to determine cerebral oxygenation as measured by near-infrared spectroscopy (NIRS) and inotropic interventions received among mechanically ventilated children in the pediatric intensive care unit (PICU). Methods: This study is a nested case − control study in the PICU of Indonesian tertiary hospital. Children aged 1 month to 17 years on mechanical ventilation and were given sedation and analgesia were included in the study. Subjects were divided into two groups according to the protocol of the main study (Clinical Trial ID NCT04788589). Cerebral oxygenation was measured by NIRS at five time points (before sedation, 5-min, 1, 6, and 12 h after sedation). Results: Thirty-nine of the 69 subjects were categorized into the protocol group and the rest were in the control group. A decrease of >20% NIRS values was found among subjects in the protocol group at 5-min (6.7%), 1-h (11.1%), 6-h (26.3%), and 12-h (23.8%) time-point. The mean NIRS value was lower and the inotropic intervention was more common in the control group (without protocol), although not statistically significant. Conclusion: This study found that mechanically ventilated children who received sedation and analgesia based on the protocol had a greater decrease of >20% NIRS values compared to the other group. The use of sedation and analgesia protocols must be applied in selected patients after careful consideration.
在儿科重症监护病房接受镇静镇痛方案的机械通气儿童与临床医生决定的脑氧合比较
摘要:充分的镇静和镇痛是影响重症监护患者康复的两个关键因素。在重症监护病人中不恰当地使用镇静和镇痛可能会导致脑氧去饱和。本研究旨在通过近红外光谱(NIRS)测量儿科重症监护病房(PICU)机械通气儿童的脑氧合和接受的肌力干预。方法:本研究是在印度尼西亚三级医院PICU进行的巢式病例对照研究。研究对象为1个月至17岁,采用机械通气并给予镇静和镇痛的儿童。根据主要研究(临床试验编号NCT04788589)的方案将受试者分为两组。在镇静前、镇静后5 min、镇静后1、6、12 h,用近红外光谱(NIRS)测定5个时间点脑氧合。结果:69例受试者中39例为方案组,其余为对照组。方案组受试者在5分钟(6.7%)、1小时(11.1%)、6小时(26.3%)和12小时(23.8%)时间点NIRS值下降了20%。平均NIRS值较低,肌力干预在对照组(无方案)中更常见,尽管没有统计学意义。结论:本研究发现,根据该方案给予镇静镇痛的机械通气儿童的NIRS值比另一组下降了20%。镇静和镇痛方案的使用必须经过仔细考虑后应用于选定的患者。
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来源期刊
CiteScore
2.90
自引率
7.10%
发文量
52
审稿时长
39 weeks
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