Sedation, Analgesia, and Paralysis during Mechanical Ventilation of Premature Infants

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• 作者：Kanecia O. Zimmerman ; MD ; MPH¹ ; P. Brian Smith ; MD ; MPH ; MHS¹ ; Daniel K. Benjamin ; PhD² ; Matthew Laughon ; MD ; MPH³ ; Reese Clark ; MD⁴ ; Chani Traube ; MD⁵ ; Til Stü ; rmer ; MD ; PhD⁶ ; Christoph P. Hornik ; MD ; MPH¹ ; ^{christoph.hornik@dm.duke.edu}
• 关键词：comfort drugs ; ventilated infants
• 刊名：The Journal of Pediatrics
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：180
• 期：Complete
• 页码：99-104.e1
• 全文大小：648 K
• 卷排序：180

文摘

To characterize administration of sedatives, analgesics, and paralytics in a large cohort of mechanically ventilated premature infants.Study designRetrospective cohort study including all infants <1500 g birth weight and <32 weeks gestational age (GA) mechanically ventilated at 348 Pediatrix Medical Group neonatal intensive care units from 1997 to 2012. The primary outcome is the proportion of mechanically ventilated days in which infants were administered drugs of interest. Multivariable logistic regression was used to evaluate the predictors of administration of drugs of interest.ResultsWe identified 85 911 mechanically ventilated infants. Infants received a drug of interest (opioids, benzodiazepines, other sedatives, and paralytics) on 433 587/1 305 413 (33%) of mechanically ventilated infant days. The administration of opioids increased during the study period from 5% of infant days in 1997 to 32% in 2012. The administration of benzodiazepines increased during the study period from 5% of infant days in 1997 to 24% in 2012. Use of paralytics and other drugs remained ≤1% throughout the study period. Predictors of drug administration included younger GA, small for GA status, male sex, presence of a major congenital anomaly, older postnatal age at intubation, exposure to high-frequency ventilation, exposure to inotropes, more recent year of discharge, and neonatal intensive care unit site.ConclusionsAdministration of opioids and benzodiazepines in mechanically ventilated premature infants increased over time. Because infant characteristics were unchanged, site-specific differences in practice likely explain our observations. Increased administration over time is concerning given limited evidence of benefit and potential for harm.