■每日镇静中断的有效性(DSI,定义为暂时中断镇静)尚未在危重儿科患者中得到证实。
■比较在儿科重症监护病房(PICU)接受有创机械通气(MV)支持的患者中,DSI与连续静脉(IV)镇静的临床结果。
■使用5个主要数据库(PubMed,Embase,WebofScience,CINAHL[护理和相关健康文献累积指数],和Cochrane中央对照试验登记册)从数据库开始到2023年10月31日。
■回顾性和前瞻性观察研究,随机临床试验(RCT),和系统综述被评估纳入。如果将DSI与PICU中需要MV的18岁或以下患者的连续IV镇静进行比较,则研究合格。
■研究特征,包括镇静剂的类型,镇静方案,和临床结果,被提取。遵循系统审查和荟萃分析(PRISMA)报告指南的首选报告项目。随机效应模型用于汇集文章的结果进行荟萃分析。
■感兴趣的主要结果是MV持续时间和PICU住院时间。次要结果包括总镇静剂量需求,不良事件(例如,与MV相关的并发症,撤回,和谵妄),和死亡率。
■共有6项RCT,其中2810名儿科患者(1569名男性[55.8%];平均年龄,最终分析包括26.5[95%CI,15.0-37.9]个月);患者的平均PRISM(儿科死亡风险)评分为13.68(95%CI,10.75-16.61)。与连续静脉镇静相比,DSI与PICU住院时间缩短相关(5项研究,n=2770;平均差[MD],-1.45[95%CI,-2.75至-0.15]天;P=0.03]。MV持续时间没有差异(5项研究,n=2750;MD,-0.93[95%CI,-1.89至0.04]天;P=.06),咪达唑仑的总剂量(3项研究,n=191;MD,-1.66[95%CI,-3.95至0.63]mg/kg)和使用吗啡(2项研究,n=189;MD,-2.63[95%CI,-7.01至1.75]mg/kg),或不良事件(风险比[RR],1.03[95%CI,0.74-1.42];P=0.88)。暴露与未暴露于DSI的患者之间的死亡率没有差异(RR,0.89[95%CI,0.55-1.46];P=.65)。
■这项系统评价和荟萃分析发现,在儿科患者中使用DSI与PICU住院时间缩短相关,而不良事件没有增加。需要进一步的研究来确定这种策略是否与改善PICU幸存者的神经发育结局有关。
UNASSIGNED: The effectiveness of daily sedation interruption (DSI, defined as temporary interruption of sedation) has yet to be demonstrated in critically ill pediatric patients.
UNASSIGNED: To compare the clinical outcomes of DSI vs continuous intravenous (IV) sedation in patients receiving invasive mechanical ventilation (MV) support in the pediatric intensive care unit (PICU).
UNASSIGNED: A systematic search for studies was conducted using predefined keywords and Medical Subject Headings in 5 major databases (PubMed, Embase, Web of Science, CINAHL [Cumulated Index to Nursing and Allied Health Literature], and Cochrane Central Register of Controlled Trials) from database inception to October 31, 2023.
UNASSIGNED: Retrospective and prospective observational studies, randomized clinical trials (RCTs), and systematic reviews were assessed for inclusion. Studies were eligible if they compared DSI to continuous IV sedation in patients aged 18 years or younger requiring MV in the PICU.
UNASSIGNED: Study characteristics, including the types of sedation, sedation protocols, and clinical outcomes, were extracted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was followed. A random-effects model was used to pool results from articles for the meta-analysis.
UNASSIGNED: The primary outcomes of interest were duration of MV and length of PICU stay. Secondary outcomes included total sedative dose requirement, adverse events (eg, complications associated with MV, withdrawal, and delirium), and mortality.
UNASSIGNED: A total of 6 RCTs with 2810 pediatric patients (1569 males [55.8%]; mean age, 26.5 [95% CI, 15.0-37.9] months) were included in the final analysis; patients had a mean PRISM (Pediatric Risk of Mortality) score of 13.68 (95% CI, 10.75-16.61). Compared with continuous IV sedation, DSI was associated with a reduction in length of PICU stay (5 studies, n = 2770; mean difference [MD], -1.45 [95% CI, -2.75 to -0.15] days; P = .03]. There was no difference in MV duration (5 studies, n = 2750; MD, -0.93 [95% CI, -1.89 to 0.04] days; P = .06), total doses of midazolam (3 studies, n = 191; MD, -1.66 [95% CI, -3.95 to 0.63] mg/kg) and morphine used (2 studies, n = 189; MD, -2.63 [95% CI, -7.01 to 1.75] mg/kg), or adverse events (risk ratio [RR], 1.03 [95% CI, 0.74-1.42]; P = .88). There was no difference in mortality between patients exposed vs not exposed to DSI (RR, 0.89 [95% CI, 0.55-1.46]; P = .65).
UNASSIGNED: This systematic review and meta-analysis found that use of DSI in pediatric patients was associated with reduced length of PICU stay with no increase in adverse events. Further research is needed to ascertain whether this strategy is associated with improved neurodevelopmental outcomes in PICU survivors.