Abstract Objective To compare the efficacy and safety of different analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit (PICU). Methods Eighty children with mechanical ventilation in the PICU who needed analgesic and sedative treatments were equally and randomly divided into midazolam group and remifentanil+midazolam group. The sedative and analgesic effects were assessed using the Ramsay Scale and the Face, Legs, Activity, Cry and Consolability (FLACC) Scale. The following indices were recorded for the two groups:vital signs, ventilator parameters, organ function, total doses of remifentanil and midazolam, duration of mechanical ventilation, length of PICU stay, PICU cost, and incidence of adverse events. Results Satisfactory sedation was achieved in the two groups, but the remifentanil+midazolam group had a significantly shorter time to analgesia and sedation than the midazolam group. The remifentanil+midazolam group had a significantly higher percentage of patients with grade 3-4 on the Ramsay Scale and a significantly lower dose of midazolam than the midazolam group (P < 0.05). Both groups showed decreases in heart rate (HR), mean arterial pressure (MAP), and spontaneous breathing frequency (RRs) after treatment. However, the remifentanil+midazolam group had significantly greater decreases in HR at 3-24 hours after treatment and MAP and RRs at 3-12 hours after treatment than the midazolam group (P < 0.05). Compared with the midazolam group, the remifentanil+midazolam group had significantly higher ventilator tidal volume and transcutaneous oxygen saturation at 6 and 12 hours after treatment and significantly lower end-tidal carbon dioxide partial pressure at 6 and 12 hours after treatment (P < 0.05). The remifentanil+midazolam group had significantly shorter time to awake, extubation time, duration of mechanical ventilation, and length of PICU stay than the midazolam group (P < 0.05). There were no significant differences in PICU cost, incidence of adverse events, and hepatic and renal functions before and after treatment between the two groups (P > 0.05). Both groups showed a significant decrease in fasting blood glucose level after treatment (P < 0.05). Conclusions For children with mechanical ventilation in the PICU, remifentanil+midazolam treatment can rapidly achieve analgesia and sedation, improve the effect of mechanical ventilation, and reduce the dose of sedative compared with midazolam alone, and is well tolerated.
CAI Xiao-Fang,ZHANG Fu-Rong,ZHANG Long et al. Efficacy of analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit[J]. CJCP, 2017, 19(11): 1138-1144.
CAI Xiao-Fang,ZHANG Fu-Rong,ZHANG Long et al. Efficacy of analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit[J]. CJCP, 2017, 19(11): 1138-1144.
Bugedo G, Tobar E, Aguirre M, et al. The implementation of an analgesia-based sedation protocol reduced deep sedation and proved to be safe and feasible in patients on mechanical ventilation[J]. Rev Bras Ter Intensiva, 2013, 25(3):188-196.
[4]
Cho YJ, Kim TK, Hong DM, et al. Effect of desflurane-remifentanil vs. propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery:a prospective randomized trial[J]. BMC Anesthesiol, 2017, 17(1):9.
[5]
Rocco M, Conti G, Alessandri E, et al. Rescue treatment for noninvasive ventilation failure due to interface intolerance with remifentanil analgosedation:a pilot study[J]. Intensive Care Med, 2010, 36(12):2060-2065.
Dahaba AA, Grabner T, Rehak PH, et al. Remifentanil versus morphine analgesia and sedation for mechanically ventilated critically ill patients:a randomized double blind study[J]. Anesthesiology, 2004, 101(3):640-646.
[8]
Kato T, Koitabashi T, Ouchi T, et al. The utility of bispectral index monitoring for sedated patients treated with low-dose remifentanil[J]. J Clin Monit Comput, 2012, 26(6):459-463.
Jenkins IA, Playfor SD, Bevan C, et al. Current United Kingdom sedation practice in pediatric intensive care[J]. Paediatr Anaesth, 2007, 17(7):675-83.
[11]
Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit[J]. Crit Care Med, 2013, 41(1):263-306.
[12]
Vincent JL, Shehabi Y, Walsh TS, et al. Comfort and patient-centred care without excessive sedation:the eCASH concept[J]. Intensive Care Med, 2016, 42(6):962-971.
[13]
Shehabi Y, Chan L, Kadiman S, et al. Sedation depth and long-term mortality in mechanically ventilated critically ill adults:a prospective longitudinal multicentre cohort study[J]. Intensive Care Med, 2013, 39(5):910-918.
[14]
Patel SB, Kress JP. Sedation and analgesia in the mechanically ventilated patient[J]. Am J Respir Crit Care Med, 2012, 185(5):486-497.
[15]
Lebherz-Eichinger D, Tudor B, Krenn CG, et al. Impact of different sedation protocols and perioperative procedures on patients admitted to the intensive care unit after maxillofacial tumor surgery of the lower jaw:A retrospective study[J]. J Craniomaxillofac Surg, 2016, 44(4):506-511.
[16]
Wujtewicz MA, Hasak L, Twardowski P, et al. Evaluation of the relationship between baseline autonomic tone and the vagotonic effect of a bolus dose of remifentanil[J]. Anaesthesia, 2016, 71(7):823-828.
