RESUMEN
Objetivo: Describir la sedación con perfusión continua de propofol en niños en estado crítico. Diseño: Estudio observacional descriptivo retrospectivo. Ámbito: Unidad de cuidados intensivos pediátricos. Pacientes: Pacientes que requirieron sedoanalgesia entre el 1 de octubre de 2009 y el 30 de septiembre de 2010.Intervenciones: Ninguna. Variables recogidas: Demográficas, clínicas, de laboratorio, diagnóstico, tratamiento, complicaciones y evolución de cada paciente. Se analizaron los posibles efectos adversos asociados a la administración de propofol, comparando el grupo de pacientes a los que se les administró con el resto de los niños críticos. Resultados: Recibieron propofol en perfusión continua 71 de los 222 pacientes recogidos (32%). Los fármacos sedoanalgésicos más utilizados fueron el midazolam, seguido del fentanilo y del propofol. La dosis media de propofol fue de 2,1mg/kg/h [desviación estándar (DE) 1,3, rango: 0,5-6)] y la duración media de 6,7 días (DE 8,5; rango: 0,5-40). La edad media fue de 45,8 meses (mediana 24; rango intercuartil: 7-65), siendo el 52% varones. Ningún paciente presentó síndrome de infusión por propofol ni otros efectos adversos graves. Los pacientes tratados con propofol presentaron con mayor frecuencia algunas alteraciones analíticas que el resto, pero no se demostró relación causa efecto con la administración del fármaco. No existieron diferencias significativas en los niveles de lactato ni en la incidencia de infecciones entre ambos grupos. Conclusión: el propofol a una dosis de 1 a 4mg/kg/h puede utilizarse como un fármaco alternativo para la sedación de mantenimiento en los niños críticamente enfermos. Sin embargo son necesarios más estudios que valoren su eficacia y seguridad (AU)
Objective To describe sedation with continuous perfusion of propofol in critically ill children. Design A retrospective, descriptive observational study was carried out. Setting A pediatric intensive care unit. Patients Pediatric patients requiring sedoanalgesia between October 1, 2009 and September 30, 2010. Interventions None. Data collected Demographic, clinical and laboratory test variables, diagnosis, treatment, complications and evolution in each patient. In addition, the potential adverse effects associated with propofol administration were analyzed. Results: Midazolam, fentanyl and propofol were the most commonly used sedative and analgesic drugs. Seventy-one out of 222 patients (32%) received propofol in continuous infusion. The average dose was 2.1mg/kg/h (SD 1.3, range: 0.5 to 6), and the average duration of treatment was of 6.7 days (SD 8.5 range 0.5-40). Fifty-two percent were males, and the mean patient age was 45.8 months (median: 24; interquartile range: 7-65). No patient developed propofol infusion syndrome or other serious drug-related adverse effects. Patients treated with propofol showed more abnormal laboratory test findings, although no relationship to drug administration could be demonstrated. There were no significant differences in lactate level or in the incidence of infection in either group. Conclusions: Propofol at a dose of 1 to 4mg/kg/h is a safe alternative for sustained sedation in critically ill children. However, further studies are needed to assess its effects and safety profile (AU)
Asunto(s)
Humanos , Masculino , Femenino , Niño , Propofol/uso terapéutico , Relación Ventilacion-Perfusión , Sedación Profunda/métodos , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Seguridad del PacienteRESUMEN
OBJECTIVE: To describe sedation with continuous perfusion of propofol in critically ill children. DESIGN: A retrospective, descriptive observational study was carried out. SETTING: A pediatric intensive care unit. PATIENTS: Pediatric patients requiring sedoanalgesia between October 1, 2009 and September 30, 2010. INTERVENTIONS: None. DATA COLLECTED: Demographic, clinical and laboratory test variables, diagnosis, treatment, complications and evolution in each patient. In addition, the potential adverse effects associated with propofol administration were analyzed. RESULTS: Midazolam, fentanyl and propofol were the most commonly used sedative and analgesic drugs. Seventy-one out of 222 patients (32%) received propofol in continuous infusion. The average dose was 2.1 mg/kg/h (SD 1.3, range: 0.5 to 6), and the average duration of treatment was of 6.7 days (SD 8.5 range 0.5-40). Fifty-two percent were males, and the mean patient age was 45.8 months (median: 24; interquartile range: 7-65). No patient developed propofol infusion syndrome or other serious drug-related adverse effects. Patients treated with propofol showed more abnormal laboratory test findings, although no relationship to drug administration could be demonstrated. There were no significant differences in lactate level or in the incidence of infection in either group. CONCLUSIONS: Propofol at a dose of 1 to 4 mg/kg/h is a safe alternative for sustained sedation in critically ill children. However, further studies are needed to assess its effects and safety profile.