右美托咪定在危重儿童机械通气中的应用:随机对照试验的系统回顾和荟萃分析。

IF 2.8 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
In Kyung Lee, Kyeong Hun Lee, Hye-Ji Han, In Young Choi, Na Jin Kim, Kyunghoon Kim
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引用次数: 0

摘要

目的:在儿科重症监护病房(PICU)接受机械通气(MV)的儿童需要有效的镇静来减少焦虑和不适。右美托咪定是一种α2受体激动剂,是一种可行的镇静替代药物。然而,它对危重症、机械通气儿童的临床结果仍有待完全确定。我们对随机对照试验(rct)进行了系统回顾和荟萃分析,以评估右美托咪定在此类患者中的临床结局和不良反应。材料与方法:系统检索至2024年4月。包括比较右美托咪定与其他镇静剂在机械通气儿童中的rct。该分析通过荟萃分析关注临床和安全性结果。结果:纳入8项试验,共涉及387例机械通气儿童。与其他镇静剂相比,右美托咪定减少了MV持续时间[平均差值-3.54小时;95%可信区间(CI), -6.49至-0.59],特别是在术后患者中,与芬太尼相比。然而,右美托咪定对ICU住院时间、镇静持续时间或额外使用镇静剂的必要性没有显著影响。右美托咪定与心动过缓的风险显著增加相关[优势比(OR) 6.14;95% CI, 2.20 ~ 17.12]和低血压(OR 8.14;95% CI, 1.37 ~ 48.31)。结论:虽然右美托咪定明显缩短了MV持续时间,但潜在的不良反应需要进一步研究。需要大量的随机对照试验来验证我们的发现,并完善PICU中机械通气儿童的镇静管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Dexmedetomidine in Mechanically Ventilated Critically Ill Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Dexmedetomidine in Mechanically Ventilated Critically Ill Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Dexmedetomidine in Mechanically Ventilated Critically Ill Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Dexmedetomidine in Mechanically Ventilated Critically Ill Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Purpose: Children undergoing mechanical ventilation (MV) in the pediatric intensive care unit (PICU) require effective sedation to reduce anxiety and discomfort. Dexmedetomidine, an α2-receptor agonist, presents as a viable sedative alternative. However, its clinical outcomes for critically ill, mechanically ventilated children remain to be fully established. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the clinical outcomes and adverse effects of dexmedetomidine in such patients.

Materials and methods: A systematic search was conducted up to April 2024. RCTs that compare dexmedetomidine with other sedatives in mechanically ventilated children were included. This analysis focused on both the clinical and safety outcomes through meta-analysis.

Results: Included in the analysis were eight trials, involving a total of 387 mechanically ventilated children. Compared to other sedatives, dexmedetomidine reduced the duration of MV [mean difference -3.54 hours; 95% confidence interval (CI), -6.49 to -0.59], particularly in post-operative patients and when compared to fentanyl. However, dexmedetomidine did not significantly impact the length of ICU stay, duration of sedation, or the necessity for additional sedatives. Dexmedetomidine was associated with a significantly increased risk of bradycardia [odds ratio (OR) 6.14; 95% CI, 2.20 to 17.12] and hypotension (OR 8.14; 95% CI, 1.37 to 48.31) compared to other sedatives.

Conclusion: Although dexmedetomidine notably diminished the duration of MV, the potential for adverse effects necessitates further investigation. Large RCTs are needed to validate our findings and refine sedation management in mechanically ventilated children in PICU.

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来源期刊
Yonsei Medical Journal
Yonsei Medical Journal 医学-医学:内科
CiteScore
4.50
自引率
0.00%
发文量
167
审稿时长
3 months
期刊介绍: The goal of the Yonsei Medical Journal (YMJ) is to publish high quality manuscripts dedicated to clinical or basic research. Any authors affiliated with an accredited biomedical institution may submit manuscripts of original articles, review articles, case reports, brief communications, and letters to the Editor.
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