Sedation Management in Pediatric Patients with Acute Respiratory Failure (DCC)

急性呼吸衰竭 (DCC) 儿科患者的镇静管理

基本信息

批准号：
8048130
负责人：
DAVID WYPIJ
金额：
$ 53.23万
依托单位：
BOSTON CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-04-01 至 2013-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8048130
关键词：
Abstinence Syndrome Acute Acute respiratory failure Adverse event Algorithms Archives Benzodiazepines Biological Models Boston Child Support Childhood Clinical Clinical Research Clinical Trials Data Monitoring Committees Confidentiality of Patient Information Consensus Critical Care Critical Illness Data Analyses Data Coordinating Center Data Quality Data Reporting Data Set Databases Depressed mood Detection Development Drug Tolerance Education Effectiveness Emotional Enrollment Ensure Environmental air flow Event Feedback Goals Health Hospital Costs Hospital Mortality Human Resources Infant Injury Intensive Care Intervention Investigation Length of Stay Life Maintenance Manuals Mechanical ventilation Monitor Multi-Institutional Clinical Trial Nature Neurologic Nurses Opioid Organizational Change Outcome Patient Care Patients Pediatric Hospitals Pediatric Intensive Care Units Performance Pharmaceutical Preparations Preparation Protocols documentation Publications Quality Control Quality of life Randomized Randomized Clinical Trials Recovery Safety Sedation procedure Services Site Substance Withdrawal Syndrome Syndrome Testing Time Titrations Training Universities Update Visit Weaning Withdrawal Symptom Work abstracting cost cost effectiveness data management experience firewall innovation instrumentation meetings operation programs quality assurance secondary outcome sedative treatment as usual

项目摘要

Description: (provided by applicant): Ensuring the safety and comfort of critically ill infants or children supported on mechanical ventilation is integral to the practice of pediatric critical care. Humane pediatric intensive care often includes sedation management. Although there are clear benefits in using sedation in pediatric patients who are unable to understand the imperative nature of critical care instrumentation and immobility, sedative use is associated with iatrogenic injury. Specifically, the medications used for sedation may depress spontaneous ventilation and prolong the duration of mechanical ventilation. Over time, drug tolerance develops and may precipitate iatrogenic withdrawal syndrome when sedation is no longer necessary. Prolonging the duration of mechanical ventilation and iatrogenic withdrawal syndrome add to the personal and financial burden of intensive care. This cluster randomized clinical trial will test an innovative approach to sedation management that includes: [a] team education and consensus on the use of sedatives in pediatric patients supported on mechanical ventilation, [b] team identification of the patient's trajectory of illness and daily prescription of a sedation goal, [c] a Nurse-Implemented Goal-Directed Comfort Algorithm that guides moment-to-moment titration of opioids and benzodiazepines, and [d] team feedback on sedation management performance. The intervention is an organizational change directed at all PICU clinicians. The unit of randomization is the PICU, the unit of inference is the patient, and we will control for center effects. Eighteen pediatric intensive care units (9 randomized to the sedation management intervention and 9 to continue to provide usual care) will enroll 2754 critically-ill infants and children supported on mechanical ventilation. We believe that patients managed per sedation protocol will experience fewer days of mechanical ventilation, less sedative exposure, fewer iatrogenic withdrawal symptoms, a shorter intensive care length of stay, less costs, and experience a better post-discharge quality of life and emotional health.

描述：（由申请人提供）：确保在机械通气支持的重症儿童或儿童的安全和舒适度是小儿重症监护实践不可或缺的一部分。人道的小儿重症监护病通常包括镇静管理。尽管在无法理解重症监护仪器和不动的小儿患者中使用镇静剂有明显的好处，但镇静剂的使用与医源性损伤有关。具体而言，用于镇静的药物可能会降低自发通风并延长机械通气的持续时间。随着时间的流逝，当不再需要镇静时，药物的耐受性会发展并可能导致医源性戒断综合征。延长机械通气和医源性戒断综合征的持续时间增加了重症监护的个人和财务负担。该集群随机临床试验将测试一种创新的镇静管理方法，其中包括：[a]团队教育和关于在儿科患者中使用镇静剂的共识，支持机械通气，[b]团队对患者疾病的轨迹的识别和镇静目标的日常处方，[c]镇静目标，[c]舒适的目标策略，以指导式仪式，以指导指导的序列，以指导指导的序列，以指导指导的序列对指导式的指导量。苯二氮卓类和[D]镇静管理绩效的反馈。干预是针对所有PICU临床医生的组织变革。随机分组是PICU，推理单位是患者，我们将控制中心效应。十八个小儿重症监护病房（9个随机分配给镇静管理干预措施，9个继续提供通常的护理）将招募2754名认真识别的婴儿和支持机械通气的儿童。我们认为，根据镇静协议进行管理的患者将减少机械通气的天数，镇静性较小，医源性戒断症状的较少，重症监护次数较短，成本较小，成本较小，体验更好的生活后生活质量和情感健康。