소아 중환자실에서의 진정제 사용 현황과 금단현상과의 상관관계 분석
Current Sedation Practice in Pediatric Intensive Care Unit and Analysis of Correlations with Withdrawal Syndrome
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Background : Although sedatives are commonly used in intensive care units, they may cause side effects such as delayed weaning of mechanical ventilation and withdrawal syndrome. There is no adequate assessment tool for evaluating the level of sedation in children and there is a lack of studies related to the use of sedatives in children. The purpose of this study was to investigate the use of sedatives in the pediatric intensive care unit (PICU) and to analyze the frequency and related factors of withdrawal syndrome. Methods : From January 1 through June 30, 2016, we retrospectively reviewed the electronic medical records of pediatric patients admitted to the PICU at the Seoul National University Children’s Hospital. The use of sedatives, tapering status, and frequency of withdrawal syndrome was investigated. Results : Ninety-three patients were treated with sedatives in the PICU at the Seoul National Children’s Hospital. Sixty-six were surgical patients, and 27 were medical patients. A combination of midazolam and fentanyl were the most commonly used sedative and analgesic (n=78, 83.9%). The median period of sedation was 60.1 hours (interquartile range (IQR) 75.8) in the surgical patients and 117.5 hours (IQR 121.2) in the medical patients. Compared to the surgical patients, long-term sedation was applied in medical patients. Tapering off of sedatives was performed in 40 patients (43.0%). The median total duration of tapering of sedatives was 16.0 hours (IQR 26.5) in the surgical patients and 30.2 hours (IQR 62.0) in the medical patients. The withdrawal syndrome occurred in 33 patients (37.1%) among 89 patients using midazolam as the main sedative. The duration of midazolam infusion was significantly associated with the frequency of withdrawal syndrome (Spearman’s rho 0.345, p=0.049). Conclusion : The withdrawal syndrome of sedatives was associated with the duration of sedation. Thus, more attention should be focused on tapering and monitoring the occurrence of withdrawal syndrome in patients requiring prolonged sedation.
Abstract
Background : Although sedatives are commonly used in intensive care units, they may cause side effects such as delayed weaning of mechanical ventilation and withdrawal syndrome. There is no adequate assessment tool for evaluating the level of sedation in children and there is a lack of studies related to the use of sedatives in children. The purpose of this study was to investigate the use of sedatives in the pediatric intensive care unit (PICU) and to analyze the frequency and related factors of withdrawal syndrome. Methods : From January 1 through June 30, 2016, we retrospectively reviewed the electronic medical records of pediatric patients admitted to the PICU at the Seoul National University Children’s Hospital. The use of sedatives, tapering status, and frequency of withdrawal syndrome was investigated. Results : Ninety-three patients were treated with sedatives in the PICU at the Seoul National Children’s Hospital. Sixty-six were surgical patients, and 27 were medical patients. A combination of midazolam and fentanyl were the most commonly used sedative and analgesic (n=78, 83.9%). The median period of sedation was 60.1 hours (interquartile range (IQR) 75.8) in the surgical patients and 117.5 hours (IQR 121.2) in the medical patients. Compared to the surgical patients, long-term sedation was applied in medical patients. Tapering off of sedatives was performed in 40 patients (43.0%). The median total duration of tapering of sedatives was 16.0 hours (IQR 26.5) in the surgical patients and 30.2 hours (IQR 62.0) in the medical patients. The withdrawal syndrome occurred in 33 patients (37.1%) among 89 patients using midazolam as the main sedative. The duration of midazolam infusion was significantly associated with the frequency of withdrawal syndrome (Spearman’s rho 0.345, p=0.049). Conclusion : The withdrawal syndrome of sedatives was associated with the duration of sedation. Thus, more attention should be focused on tapering and monitoring the occurrence of withdrawal syndrome in patients requiring prolonged sedation.
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