Effect of sequential sedation and analgesia in preventing delirium and withdrawal symptoms in children after ventilator weaning

YANG Wen-Hai, LAI Zhi-Jun, LI Yan, MA Ke-Ze

Chinese Journal of Contemporary Pediatrics ›› 2022, Vol. 24 ›› Issue (7) : 748-752.

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Chinese Journal of Contemporary Pediatrics ›› 2022, Vol. 24 ›› Issue (7) : 748-752. DOI: 10.7499/j.issn.1008-8830.2202114
CLINICAL RESEARCH

Effect of sequential sedation and analgesia in preventing delirium and withdrawal symptoms in children after ventilator weaning

  • YANG Wen-Hai, LAI Zhi-Jun, LI Yan, MA Ke-Ze
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Abstract

Objective To investigate the effect of sequential sedative and analgesic drugs in preventing delirium and withdrawal symptoms in children after ventilator weaning. Methods A retrospective analysis was performed on 61 children who were admitted and received mechanical ventilation support for ≥5 days in the Pediatric Intensive Care Unit of Dongguan Children's Hospital Affiliated to Guangdong Medical University from December 2019 to September 2021. The children were divided into a control group (30 children with no maintenance of analgesic and sedative drugs after ventilator weaning) and an observation group (31 children with sequential sedative and analgesic drugs maintained for 48 hours after ventilator weaning). The two groups were compared in terms of the Sophia Observation Withdrawal Symptoms Scale (SOS) score, the Pediatric Delirium Scale (PD) score, the Richmond Agitation-Sedation Scale (RASS) score, and the incidence rates of delirium or withdrawal symptoms at 24 and 72 hours after ventilator weaning. Results There was no significant difference in the incidence rate of delirium at 24 hours and 72 hours after ventilator weaning between the two groups (P>0.05). Compared with the control group, the observation group had significantly lower incidence rate of withdrawal symptoms and scores of SOS, PD, and RASS scales at 24 hours and 72 hours after ventilator weaning (P<0.01). Conclusions Sequential sedation and analgesia after ventilator weaning can reduce the incidence of withdrawal symptoms within 72 hours after ventilator weaning, but it cannot reduce the incidence rate of delirium.

Key words

Delirium / Withdrawal symptom / Analgesia and sedation / Mechanical ventilation / Child

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YANG Wen-Hai, LAI Zhi-Jun, LI Yan, MA Ke-Ze. Effect of sequential sedation and analgesia in preventing delirium and withdrawal symptoms in children after ventilator weaning[J]. Chinese Journal of Contemporary Pediatrics. 2022, 24(7): 748-752 https://doi.org/10.7499/j.issn.1008-8830.2202114

References

1 Janssen NJ, Tan EY, Staal M, et al. On the utility of diagnostic instruments for pediatric delirium in critical illness: an evaluation of the Pediatric Anesthesia Emergence Delirium Scale, the Delirium Rating Scale 88, and the Delirium Rating Scale-Revised R-98[J]. Intensive Care Med, 2011, 37(8): 1331-1337. PMID: 21567109. PMCID: PMC3136686. DOI: 10.1007/s00134-011-2244-y.
2 Patel AK, Biagas KV, Clarke EC, et al. Delirium in children after cardiac bypass surgery[J]. Pediatr Crit Care Med, 2017, 18(2): 165-171. PMID: 27977539. PMCID: PMC5658045. DOI: 10.1097/PCC.0000000000001032.
3 Staveski SL, Pickler RH, Khoury PR, et al. Prevalence of ICU delirium in postoperative pediatric cardiac surgery patients[J]. Pediatr Crit Care Med, 2021, 22(1): 68-78. PMID: 33065733. DOI: 10.1097/PCC.0000000000002591.
4 Traube C, Silver G, Kearney J, et al. Cornell assessment of pediatric delirium: a valid, rapid, observational tool for screening delirium in the PICU*[J]. Crit Care Med, 2014, 42(3): 656-663. PMID: 24145848. PMCID: PMC5527829. DOI: 10.1097/CCM.0b013e3182a66b76.
5 何珊, 王亚力, 左泽兰. 中文版康奈尔儿童谵妄量表的临床初步应用[J]. 中华儿科杂志, 2019, 57(5): 344-349. PMID: 31060126. DOI: 10.3760/cma.j.issn.0578-1310.2019.05.006.
6 Wang J, Ji Y, Wang N, et al. Risk factors for the incidence of delirium in cerebrovascular patients in a neurosurgery intensive care unit: a prospective study[J]. J Clin Nurs, 2018, 27(1-2): 407-415. PMID: 28677160. DOI: 10.1111/jocn.13943.
7 王小亭, 汤铂, 刘大为. 重症谵妄: 一个古老传说的新篇章[J]. 中华内科杂志, 2019, 58(2): 83-84. PMID: 30704192. DOI: 10.3760/cma.j.issn.0578-1426.2019.02.002.
8 高嘉颖, 钱娟, 王筱金, 等. 儿童重症监护病房镇痛镇静治疗撤药模式对戒断综合征的影响[J]. 中华儿科杂志, 2020, 58(4): 284-289. PMID: 32234134. DOI: 10.3760/cma.j.cn112140-20191217-00817.
9 Ista E, van Beusekom B, van Rosmalen J, et al. Validation of the SOS-PD scale for assessment of pediatric delirium: a multicenter study[J]. Crit Care, 2018, 22(1): 309. PMID: 30458826. PMCID: PMC6247513. DOI: 10.1186/s13054-018-2238-z.
10 Ista E, Te Beest H, van Rosmalen J, et al. Sophia Observation withdrawal Symptoms-Paediatric Delirium scale: a tool for early screening of delirium in the PICU[J]. Aust Crit Care, 2018, 31(5): 266-273. PMID: 28843537. DOI: 10.1016/j.aucc.2017.07.006.
11 Dervan LA, Di Gennaro JL, Farris RWD, et al. Delirium in a tertiary PICU: risk factors and outcomes[J]. Pediatr Crit Care Med, 2020, 21(1): 21-32. PMID: 31568239. DOI: 10.1097/PCC.0000000000002126.
12 中华医学会儿科学分会急救学组, 中华医学会急诊医学分会儿科学组, 中国医师协会儿童重症医师分会. 中国儿童重症监护病房镇痛和镇静治疗专家共识(2018版)[J]. 中华儿科杂志, 2019, 57(5): 324-330. PMID: 31060122. DOI: 10.3760/cma.j.issn.0578-1310.2019.05.002.
13 Schieveld JNM, Strik JJMH. Delirium in developmentally disabled PICU children: the Richmond Agitation Sedation Scale and delirium fluctuation issue[J]. Pediatr Crit Care Med, 2020, 21(5): 494-495. PMID: 32358329. DOI: 10.1097/PCC.0000000000002250.
14 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5[M]. 5th ed. Arlington, VA: American Psychiatric Association, 2013.
15 许峰. 国内外镇痛镇静指南理念的进展[J]. 中国小儿急救医学, 2020, 27(2): 84-85. DOI: 10.3760/cma.j.issn.1673-4912.2020.02.002.
16 Traube C, Ariagno S, Thau F, et al. Delirium in hospitalized children with cancer: incidence and associated risk factors[J]. J Pediatr, 2017, 191: 212-217. PMID: 29173309. DOI: 10.1016/j.jpeds.2017.08.038.
17 Mody K, Kaur S, Mauer EA, et al. Benzodiazepines and development of delirium in critically ill children: estimating the causal effect[J]. Crit Care Med, 2018, 46(9): 1486-1491. PMID: 29727363. PMCID: PMC6095819. DOI: 10.1097/CCM.0000000000003194.
18 Meyburg J, Dill ML, Traube C, et al. Patterns of postoperative delirium in children[J]. Pediatr Crit Care Med, 2017, 18(2): 128-133. PMID: 27776085. DOI: 10.1097/PCC.0000000000000993.
19 Ista E, de Hoog M, Tibboel D, et al. Psychometric evaluation of the Sophia Observation Withdrawal Symptoms Scale in critically ill children[J]. Pediatr Crit Care Med, 2013, 14(8): 761-769. PMID: 23962832. DOI: 10.1097/PCC.0b013e31829f5be1.
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