ABSTRACT
Objetivo Conocer la incidencia de síndrome de abstinencia tras perfusión prolongada de fentanilo y midazolam en niños, y los factores de riesgo asociados. Diseño Estudio de cohorte histórica o retrospectiva. Ámbito UCI pediátrica de seis camas de un hospital universitario. Pacientes Se incluyen 48 pacientes pediátricos que recibieron sedoanalgesia en perfusión continua con midazolam y fentanilo exclusivamente, durante al menos 48 horas. Intervenciones Ninguna. Variables de interés principales Se recogen datos clínicos y demográficos, dosis y duración de sedoanalgesia recibida, aparición de síndrome de abstinencia, gravedad y tratamiento del mismo. Resultados El 50% desarrolló síndrome de abstinencia. Hubo diferencias significativas entre los que lo desarrollaron y los que no en cuanto a duración del tratamiento previo y dosis acumulada de ambos fármacos. Una dosis acumulada de fentanilo de 0,48mg/kg o de midazolam de 40mg/kg, y una duración de la perfusión de ambos de 5,75 días fueron factores de riesgo para el desarrollo de abstinencia. La mayoría presentó un cuadro leve o moderado, que comenzó a las 12-36 horas de suspender la perfusión. El fármaco más utilizado en el tratamiento fue la metadona. Conclusiones La incidencia de síndrome de abstinencia en niños tras perfusión prolongada de midazolam y fentanilo es elevada. El desarrollo del síndrome se relaciona con tiempos de perfusión prolongados y con dosis acumuladas elevadas de ambos fármacos (AU)
Objective To determine the incidence of withdrawal syndrome after prolonged infusion of fentanyl and midazolam in children, and the associated risk factors. Design Historic or retrospective cohort study. Setting Pediatric Intensive Care Unit in an academic center. Patients Forty-eight pediatric patients who received sedation and analgesia only with fentanyl and midazolam through continuous infusion for at least 48hours.InterventionsNone.Main variables of interest Collected data included demographic and clinical parameters, dose and duration of sedation received, and incidence, severity and treatment of withdrawal syndrome. Results Fifty percent of the patients developed withdrawal syndrome. There were significant differences between the patients who developed withdrawal syndrome and those who did not, in terms of the duration of infusion and the cumulative doses of both drugs. A cumulative fentanyl dose of 0.48mg/kg, a cumulative midazolam dose of 40mg/kg, and a duration of infusion of both drugs of 5.75 days were risk factors for the development of withdrawal syndrome. Most children developed mild or moderate disease, beginning about 12-36hours after weaning from infusion. Methadone was used in most cases for treating with drawal. Conclusions There is a high incidence of withdrawal syndrome in children following the continuous infusion of midazolam and fentanyl. The duration of infusion of both drugs and higher cumulative doses are associated with the development of withdrawal syndrome (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Neonatal Abstinence Syndrome/epidemiology , Fentanyl/adverse effects , Midazolam/adverse effects , Critical Care/methods , Intensive Care Units/statistics & numerical data , Retrospective Studies , Pregnancy Complications/drug therapyABSTRACT
OBJECTIVE: To determine the incidence of withdrawal syndrome after prolonged infusion of fentanyl and midazolam in children, and the associated risk factors. DESIGN: Historic or retrospective cohort study. SETTING: Pediatric Intensive Care Unit in an academic center. PATIENTS: Forty-eight pediatric patients who received sedation and analgesia only with fentanyl and midazolam through continuous infusion for at least 48 hours. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Collected data included demographic and clinical parameters, dose and duration of sedation received, and incidence, severity and treatment of withdrawal syndrome. RESULTS: Fifty percent of the patients developed withdrawal syndrome. There were significant differences between the patients who developed withdrawal syndrome and those who did not, in terms of the duration of infusion and the cumulative doses of both drugs. A cumulative fentanyl dose of 0.48 mg/kg, a cumulative midazolam dose of 40 mg/kg, and a duration of infusion of both drugs of 5.75 days were risk factors for the development of withdrawal syndrome. Most children developed mild or moderate disease, beginning about 12-36 hours after weaning from infusion. Methadone was used in most cases for treating withdrawal. CONCLUSIONS: There is a high incidence of withdrawal syndrome in children following the continuous infusion of midazolam and fentanyl. The duration of infusion of both drugs and higher cumulative doses are associated with the development of withdrawal syndrome.
Subject(s)
Analgesics, Opioid/adverse effects , Fentanyl/adverse effects , Hypnotics and Sedatives/adverse effects , Midazolam/adverse effects , Substance Withdrawal Syndrome/epidemiology , Adolescent , Child , Child, Preschool , Cohort Studies , Female , Humans , Incidence , Infant , Infant, Newborn , Intensive Care Units, Pediatric , Male , Retrospective Studies , Risk Factors , Time FactorsABSTRACT
Objetivo: Valorar la fiabilidad de la medición de la presión transcutánea de dióxido de carbono (PtCO2) respecto a la medición de la presión arterial de dióxido de carbono (PaCO2). Material y métodos: Estudio analítico, observacional, longitudinal y prospectivo. Cohorte de pacientes ingresados en unidad de cuidados intensivos pediátricos. La PtCO2 se midió con el monitor digital SenTec, aplicando el sensor con un anillo específico (sensor V-sign, versión MDB 04.04.02). Se recogieron al mismo tiempo la PtCO2 y PaCO2. La significación estadística de la asociación se calculó mediante el test F de Snedecor, el coeficiente de correlación r2 de Pearson y el coeficiente de correlación intraclase. El grado de acuerdo se estimó con el método de Bland y Altman. La consistencia de los resultados se estudió con el ANOVA. Resultados: Se compararon 106 mediciones pareadas de PtCO2 y PaCO2, de 12 pacientes. Las PaCO2 y PtCO2 medias fueron 51,0±13mmHg y 50,1±14mmHg; r2=0,87 (p<0,001), CCI=0,96 (IC: 0,940,97). El análisis de Bland-Altman mostró una media de las diferencias de−0,9mmHg (IC:−2,0 a 0,2mmHg). La correlación fue mejor en ausencia de patología respiratoria, con asistencia respiratoria baja, con PaCO2>50mmHg y con aplicación frontal del sensor. Hubo consistencia de los resultados. No se observaron efectos secundarios derivados de la utilización del anillo. Conclusiones: La correlación obtenida entre la PtCO2 y PaCO2 fue muy buena. El monitor digital SenTec y el sensor de anillo específico constituyen una herramienta fiable, segura y fácil de utiliza (AU)
Objective: To estimate the accuracy of the transcutaneous carbon dioxide tension measurement (PtCO2) compared to the measurement of the arterial carbon dioxide tension (PaCO2). Material and methods: An analytical, longitudinal, prospective and observational study, of a dynamic cohort taken from the in-patients of a Paediatric Intensive Care Unit (PICU). The PtCO2 was measured with the SenTec AG analyzer, and the sensor was applied with the specific Multi-Site Attachment Ring. PtCO2 and PaCO2 were recorded at the same time. The statistical significance of the association between paired measurements was evaluated with the Snedecor's F test, the Pearson's r2 correlation coefficient and the Interclass Correlation Coefficient (ICC). The degree of agreement was evaluated with the Bland & Altman method. The consistency of the results was evaluated with the ANalysis Of the VAriance (ANOVA). Results: One hundred and six paired measurements, PtCO2 and PaCO2, from twelve patients, were compared. The means of the PaCO2 and PtCO2 were 51.0±13mmHg and 50.1±14mmHg, respectively; r2=0.87 (p<0.001), ICC=0.96, (95% CI: 0.940.97). The Bland-Altman analysis showed a mean difference of−0.9mmHg (95% CI:−2.0 to 0.2mmHg). The correlation was better in cases with no respiratory disease, with low respiratory assistance, with PaCO2>50mmHg and with the sensor applied on the forehead. The results were consistent. No side effects derived from the use of the ring were observed. Conclusion: The correlation between PtCO2 and PaCO2 is excellent and stable. The ring sensor was safe and easy to us (AU)
Subject(s)
Humans , Male , Female , Child , Critical Care/methods , Critical Care/methods , Partial Pressure , Carbon Dioxide/administration & dosage , Carbon Dioxide/therapeutic use , Monitoring, Physiologic/methods , Drug Monitoring/trends , Signs and Symptoms , Prospective Studies , Longitudinal Studies , Analysis of VarianceABSTRACT
OBJECTIVE: To estimate the accuracy of the transcutaneous carbon dioxide tension measurement (PtCO(2)) compared to the measurement of the arterial carbon dioxide tension (PaCO(2)). MATERIAL AND METHODS: An analytical, longitudinal, prospective and observational study, of a dynamic cohort taken from the in-patients of a Paediatric Intensive Care Unit (PICU). The PtCO(2) was measured with the SenTec AG analyzer, and the sensor was applied with the specific Multi-Site Attachment Ring. PtCO(2) and PaCO(2) were recorded at the same time. The statistical significance of the association between paired measurements was evaluated with the Snedecor's F test, the Pearson's r(2) correlation coefficient and the Interclass Correlation Coefficient (ICC). The degree of agreement was evaluated with the Bland & Altman method. The consistency of the results was evaluated with the ANalysis Of the VAriance (ANOVA). RESULTS: One hundred and six paired measurements, PtCO(2) and PaCO(2), from twelve patients, were compared. The means of the PaCO(2) and PtCO(2) were 51.0+/-13mmHg and 50.1+/-14mmHg, respectively; r(2)=0.87 (p<0.001), ICC=0.96, (95% CI: 0.94-0.97). The Bland-Altman analysis showed a mean difference of-0.9mmHg (95% CI:-2.0 to 0.2mmHg). The correlation was better in cases with no respiratory disease, with low respiratory assistance, with PaCO(2)>50mmHg and with the sensor applied on the forehead. The results were consistent. No side effects derived from the use of the ring were observed. CONCLUSION: The correlation between PtCO(2) and PaCO(2) is excellent and stable. The ring sensor was safe and easy to use.
Subject(s)
Blood Gas Monitoring, Transcutaneous , Critical Illness , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Prospective StudiesABSTRACT
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