Strategies for the management and prevention of withdrawal syndrome in critically ill pediatric patients: a systematic review

Q2 Medicine
Kassiely Klein, Jéssica Silveira Pereira, Kátia Adriana Lins Jaines Curtinaz, L. Jantsch, Neila Santini de Souza, P. Carvalho
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引用次数: 1

Abstract

Objective To verify strategies for the prevention and treatment of abstinence syndrome in a pediatric intensive care unit. Methods This is a systematic review in the PubMed database®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review and CENTRAL. A three-step search strategy was used for this review, and the protocol was approved in PROSPERO (CRD42021274670). Results Twelve articles were included in the analysis. There was great heterogeneity among the studies included, especially regarding the therapeutic regimens used for sedation and analgesia. Midazolam doses ranged from 0.05mg/kg/hour to 0.3mg/kg/hour. Morphine also varied considerably, from 10mcg/kg/hour to 30mcg/kg/hour, between studies. Among the 12 selected studies, the most commonly used scale for the identification of withdrawal symptoms was the Sophia Observational Withdrawal Symptoms Scale. In three studies, there was a statistically significant difference in the prevention and management of the withdrawal syndrome due to the implementation of different protocols (p < 0.01 and p < 0.001). Conclusion There was great variation in the sedoanalgesia regimen used by the studies and the method of weaning and evaluation of withdrawal syndrome. More studies are needed to provide more robust evidence about the most appropriate treatment for the prevention and reduction of withdrawal signs and symptoms in critically ill children. PROSPERO register CRD 42021274670
危重儿科患者戒断综合征的管理和预防策略:系统综述
目的探讨小儿重症监护病房戒断综合征的防治策略。方法对PubMed数据库®、Lilacs、Embase、Web of Science、Cochrane、Cinahl、Cochrane database system review和CENTRAL进行系统综述。本综述采用三步搜索策略,该方案在普洛斯彼罗(CRD42021274670)中获得批准。结果共纳入12篇文献。纳入的研究存在很大的异质性,特别是关于镇静和镇痛的治疗方案。咪达唑仑的剂量范围为0.05mg/kg/小时至0.3mg/kg/小时。在不同的研究中,吗啡的变化也很大,从每小时10mcg到每小时30mcg。在选取的12项研究中,最常用的戒断症状识别量表是索菲亚观察性戒断症状量表。在三项研究中,由于不同方案的实施,戒断综合征的预防和管理差异有统计学意义(p < 0.01和p < 0.001)。结论各研究采用的镇痛方案、断奶方法及戒断综合征评价方法存在较大差异。需要进行更多的研究,以提供更有力的证据,证明预防和减少危重儿童戒断体征和症状的最适当治疗方法。普洛斯彼罗注册编号42021274670
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来源期刊
Revista Brasileira de Terapia Intensiva
Revista Brasileira de Terapia Intensiva Medicine-Critical Care and Intensive Care Medicine
自引率
0.00%
发文量
114
审稿时长
15 weeks
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