Anesthesia, Sedation, and Unplanned Extubation of Tracheal Intubation in Children with Severe Pneumonia.

Zengchun Wang,Hua Cao,Yu Huang,Qiang Chen,Lingshan Yu,Songwen Tan

doi:10.1155/2021/4802389

Abstract

We randomly divided 200 children with severe pneumonia who met the indications for tracheal intubation into 2 groups in this prospective study. One group that received dexmedetomidine for sedation was recorded as the dexmedetomidine group (n = 100), and the group that received midazolam for sedation was recorded as the midazolam group (n = 100). We compared the anesthesia sedation scores, time to fall asleep, time to wake up from anesthesia, related hemodynamic parameters, and adverse reactions between the two groups of children. The failure mode and effect analysis method (FMEA) was also used to investigate the causes of unplanned extubation (UEX) of tracheal intubation in 32 children with severe pneumonia. Our conclusion is as follows: (1) Compared with midazolam, the comprehensive effect of dexmedetomidine on children with severe pneumonia undergoing tracheal intubation for anesthesia and sedation is better, it can effectively shorten the anesthesia induction time and the recovery time after stopping the drug, and there are few adverse reactions, which is worthy of application and promotion. (2) UEX is an important risk factor in the monitoring and nursing of children with severe pneumonia tracheal intubation, and the nursing method of PDCA cycle management is particularly important for them.

Highlights

Severe pneumonia is a more common critical illness in pediatrics, and some children often need mechanical ventilation for respiratory failure [1, 2]
From January 2018 to April 2021, 200 children with severe pneumonia who met the indications for tracheal intubation were randomly divided into 2 groups
Inclusion Criteria. e inclusion criteria included the following: (1) those who met the “Expert Consensus on Clinical Practice of Severe Emergency Pneumonia in China” for the diagnosis of severe pneumonia; (2) those under the age of 14; (3) those who met the indications for tracheal intubation and were intubated through the mouth; (4) those with normal physical, cognitive, and IQ development; (5) expected intubation time greater than or equal to 48 h; (6) those whose family members had signed and agreed

Summary

Introduction

Severe pneumonia is a more common critical illness in pediatrics, and some children often need mechanical ventilation for respiratory failure [1, 2]. Midazolam is one of the classic drugs for clinical anesthesia and sedation and belongs to benzodiazepines, which is suitable for pediatric surgical treatment because of its rapid onset and low toxicity [4, 5]. It has a certain dose-dependent effect and will cause a slight inhibition of the respiratory system, so its advantages in the treatment of children with severe pneumonia are not very significant [6]. In view of the fact that the current application of dexmedetomidine in adults is relatively mature, but compared with traditional sedative drugs, its advantages in pediatric anesthesia and sedation are still in the exploratory stage. erefore, we analyzed and compared the anesthetic sedation effect and safety of midazolam and dexmedetomidine for mechanical

Methods

Results

Discussion

Conclusion