戒断评估工具- α -2激动剂的开发和初步测试:监测接受α -2激动剂的儿童医源性戒断症状的评估工具。

IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE
Pediatric Critical Care Medicine Pub Date : 2025-01-01 Epub Date: 2024-12-03 DOI:10.1097/PCC.0000000000003645
Jean C Solodiuk, Carolina Donado, Lia Wickerham, Lindsay Goodyear, John Hayes, Rachel E Mortell, Christine D Greco, Martha A Q Curley
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引用次数: 0

摘要

目的:开发并开展戒断评估工具- α 2激动剂(water - a2a)监测急性患儿右美托咪定和可乐定戒断症状的初步试验。设计:三相仪器开发研究。第1阶段:记录右美托咪定戒断的儿童表现出症状的回顾性图表回顾;第二阶段:基于第一阶段数据构建wata - a2a仪器;第3期:在停用α - 2激动剂(a2a)的儿童中进行WAT-A2A的前瞻性试验。环境:学术性独立儿童医院。患者:急性患儿停用右美托咪定至少5天。排除同时停用其他镇静剂的儿童。干预措施:没有。测量和主要结果:第一阶段:在83年的303个孩子断奶至少5天的dexmedetomidine临床文档和管理,负责撤军,88% (n = 72)表现出至少增加20%心率(HR)、83% (n = 69)表现出激动或改变在通常状态的行为,46% (n = 38)表现出至少增加20%舒张压(菲律宾),记录,56%(27/48)表现出地震期间,负责撤军。第2阶段:基于第1阶段的数据构建WAT-A2A,包括四个项目:HR,状态行为,DBP和震颤。第三阶段:对82例从A2A断奶的儿童进行了测试,并取得了良好的效果。WAT-A2A总分与临床医师主观评价A2A戒断相关(Spearman相关系数= 0.5;P < 0.001)。评价者间一致性,比较前瞻性收集的瓦特- a2a数据的成对评价,表明评价者间信度中等。结论:急性患儿服用A2A镇静超过5天可能产生生理性依赖,需要逐渐减少剂量。虽然建议进行进一步的心理测试,但WAT-A2A提供了一个客观的工具,帮助临床医生量化急性患儿右美托咪定戒断症状,可能有助于A2A断奶并限制实践中不必要的变化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Development and Preliminary Testing of the Withdrawal Assessment Tool-Alpha 2 Agonist: An Assessment Instrument for Monitoring Iatrogenic Withdrawal Symptoms in Children Receiving an Alpha-2 Agonist.

Objectives: To develop and conduct preliminary testing of the Withdrawal Assessment Tool-Alpha 2 Agonist (WAT-A2A) to monitor dexmedetomidine and clonidine withdrawal symptoms in acutely ill children.

Design: Three-phase instrument development study. Phase 1: retrospective chart review of symptoms exhibited by children with documented dexmedetomidine withdrawal; phase 2: WAT-A2A instrument construction based on phase 1 data; and phase 3: prospective testing of the WAT-A2A in children weaning from alpha 2 agonists (A2As).

Setting: Academic free-standing children's hospital.

Patients: Acutely ill children weaning from at least 5 days of dexmedetomidine. Excluded were children concurrently weaning other sedatives.

Interventions: None.

Measurements and main results: Phase 1: In 83 of 303 children weaning from at least 5 days of dexmedetomidine who had clinician documentation and were managed for A2A withdrawal, 88% ( n = 72) exhibited at least a 20% increase in heart rate (HR), 83% ( n = 69) exhibited agitation or change in usual state behavior, 46% ( n = 38) exhibited at least a 20% increase in diastolic blood pressure (DBP), and when documented, 56% (27/48) exhibited tremors during their A2A withdrawal episode. Phase 2: The WAT-A2A was constructed, based on phase 1 data, and includes four items: HR, state behavior, DBP, and tremors. Phase 3: The WAT-A2A was tested and performed well in 82 children weaning from A2A. The total WAT-A2A score correlated with clinician subjective assessment of A2A withdrawal (Spearman correlation = 0.5; p < 0.001). Inter-rater agreement, comparing paired ratings of prospectively collected WAT-A2A data, indicated moderate inter-rater reliability.

Conclusions: Acutely ill children receiving sedation with an A2A for more than 5 days may develop physiologic dependence, requiring gradual dosing reductions. While further psychometric testing is advised, the WAT-A2A provides an objective instrument to help clinicians quantify dexmedetomidine withdrawal symptoms in acutely ill children may facilitate A2A weaning and limit unnecessary variation in practice.

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来源期刊
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine 医学-危重病医学
CiteScore
7.40
自引率
14.60%
发文量
991
审稿时长
3-8 weeks
期刊介绍: Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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