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Çocuk Yoğun Bakımlarda Geliştirilmiş Sedo-Analjezi İzlem Protokollerinin Sedasyon Düzeyi İzlemine Etkisi: Bir Sistematik Derleme ve Meta-Analiz

Year 2025, Volume: 3 Issue: 1, 30 - 38

Özlem Sultan Dernek , Murat Bektaş

https://doi.org/10.61535/bseusbfd.1422367

Abstract

Bu çalışma, çocuk yoğun bakımlarda geliştirilen sedo-analjezi izlem protokollerinin çocukların sedasyon düzeylerini izlemedeki etkinliğini değerlendirmek amacıyla sistematik derleme ve meta analiz tekniği kullanılarak gerçekleştirilmiştir. Çalışmaya 1 ay-18 yaş aralığındaki çocuklar alınmıştır. Hedge’s g etki büyüklüğü değeri etki büyüklüğü istatistiği olarak kullanılmıştır. Tarama sonucunda ulaşılan 11 çalışmadan dört tanesi çocukların sedasyon düzeylerinin izlenmesini önceki dönem ile sayısal olarak karşılaştırmaktadır. Bu dört çalışma meta–analize dahil edilmiştir. Analiz sonucunda Cochrane Q değeri anlamlı ve I2 değeri %88,37 bulunmuştur. Rastgele etki modelinde Hedges’s g=-0,038 ve p=0.839 olarak saptanmıştır. Bu çalışmada, çocuk yoğun bakımlarda geliştirilen sedo-analjezi izlem protokollerinin sedasyon izlemi üzerine etkisinin anlamlı olmayabileceği belirlenmiştir.

Keywords

Çocuk Yoğun Bakım Sedasyon Analjezi Sedo-Analjezi Protokol

References

  • Akkoyun, S., & Arslan, F. T. (2022). Pediatrik Anestezi Sonrası Çocukların Ağrı Düzeyleri ve Hemşirelik Girişimlerinin Değerlendirmesi: Retrospektif Tanımlayıcı Çalışma. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 11(3), 1114- 1120. https://doi.org/10.37989/gumussagbil.1138822
  • Alexander, E., Carnevale, F. A., & Razack, S. (2002). Evaluation of a sedation protocol for intubated critically ill children. Intensive and critical care Nursing, 18(5), 292-301. https://doi.org/10.1016/S0964339702000502
  • Beytut, D., & Başbakkal, Z. (2013). Çocuk Yoğun Bakımda Sedasyon Değerlendirmesi ve Konfor Skalasının Kullanımı. Yoğun Bakım Hemşireliği Dergisi, 17(2), 52-58.
  • Curley, M. A., Wypij, D., Watson, R. S., Grant, M. J. C., Asaro, L. A., ... & Matthay, M. A. (2015). Protocolized sedation vs usual care in pediatric patients mechanically ventilated for acute respiratory failure: a randomized clinical trial. Jama, 313(4), 379-389. https://doi.org/10.1001%2Fjama.2014.18399
  • Deeter, K. H., King, M. A., Ridling, D., Irby, G. L., Lynn, A. M., & Zimmerman, J. J. (2011). Successful implementation of a pediatric sedation protocol for mechanically ventilated patients. Critical care medicine, 39(4), 683-688. https://doi.org/10.1097/CCM.0b013e318206cebf Dreyfus, L., Javouhey, E., Denis, A., Touzet, S., & Bordet, F. (2017). Implementation and evaluation of a paediatric nurse- driven sedation protocol in a paediatric intensive care unit. Annals of intensive care, 7(1), 1-13. https://doi.org/10.1186/s13613-017-0256-7
  • Erden, S. (2015). Yoğun bakımda ağrı yönetiminde hemşirenin anahtar rolleri. Van Tıp Dergisi, 22(4), 332-336.
  • Erickson, S. J., Millar, J., Anderson, B. J., Festa, M. S., Straney, L., … & Long, D. A. (2020). Dexmedetomidine sedation in mechanically ventilated critically ill children: a pilot randomized controlled trial. Pediatric Critical Care Medicine, 21(9),e731-e739. https://doi.org/10.1097/PCC.0000000000002483
  • Hanser, A., Neunhoeffer, F., Hayer, T., Hofbeck, M., Schlensak, C., ... & Michel, J. (2020). A nurse‐driven analgesia and sedation protocol reduces length of PICU stay and cumulative dose of benzodiazepines after corrective surgery for tetralogy of Fallot. Journal for specialists in pediatric nursing, 25(3), e12291. https://doi.org/10.1111/jspn.12291 Ista, E., De Hoog, M., Tibboel, D., & Van Dijk, M. (2009). Implementation of standard sedation management in paediatric intensive care: effective and feasible? Journal of clinical nursing, 18(17), 2511-2520. https://doi.org/10.1111/j.1365-2702.2009.02836.x
  • Ista, E., van Dijk, M., Gamel, C., Tibboel, D., & de Hoog, M. (2008). Withdrawal symptoms in critically ill children after long-term administration of sedatives and/or analgesics: a first evaluation. Critical care medicine, 36(8), 2427- 2432. https://doi.org/10.1097/CCM.0b013e318181600d
  • Jacobi, J., Fraser, G. L., Coursin, D. B., Riker, R. R., Fontaine, D., Wittbrodt, E. T., ... & Lumb, P. D. (2002). Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Critical care medicine, 30(1), 119-141.
  • Jin, H. S., Yum, M. S., Kim, S. L., Shin, H. Y., Lee, E. H., ... & Park, S. J. (2007). The efficacy of the COMFORT scale in assessing optimal sedation in critically ill children requiring mechanical ventilation. Journal of Korean medical science, 22(4), 693-697. https://doi.org/10.3346/jkms.2007.22.4.693
  • Konateke, S., & Güngörmüş, Z. (2022). Yoğun Bakımda Ağrı, Sedasyon ve Konfor Yönetiminde Hemşirenin Rolü. Socıal Scıences Studıes Journal (SSSJournal), 4(20), 3041-3045. http://dx.doi.org/10.26449/sssj.685
  • Larson, G. E., & McKeever, S. (2018). Nurse titrated analgesia and sedation in intensive care increases the frequency of comfort assessment and reduces midazolam use in paediatric patients following cardiac surgery. Australian Critical Care, 31(1), 31-36. https://doi.org/10.1016/j.aucc.2017.02.001
  • Michel, J., Hofbeck, M., Peper, A. K., Kumpf, M., & Neunhoeffer, F. (2020). Evaluation of an updated sedation protocol to reduce benzodiazepines in a pediatric intensive care unit. Current Medical Research and Opinion, 36(1), 1-6. https://doi.org/10.1080/03007995.2019.1663689
  • Neunhoeffer, F., Kumpf, M., Renk, H., Hanelt, M., Berneck, N., ... & Hofbeck, M. (2015). Nurse‐driven pediatric analgesia and sedation protocol reduces withdrawal symptoms in critically ill medical pediatric patients. Pediatric Anesthesia, 25(8), 786-794. https://doi.org/10.1111/pan.12649
  • Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., ... & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery, 88, 105906. https://doi.org/10.1136/bmj.n71
  • Poh, Y. N., Poh, P. F., Buang, S. N. H., & Lee, J. H. (2014). Sedation guidelines, protocols, and algorithms in PICUs: a systematic review. Pediatric Critical Care Medicine, 15(9), 885-892. https://doi.org/10.1097/PCC.0000000000000255
  • Popernack, M. L., Thomas, N. J., & Lucking, S. E. (2004). Decreasing unplanned extubations: utilization of the Penn State Children’s Hospital sedation algorithm. Pediatric critical care medicine, 5(1), 58-62. https://doi.org/10.1097/01.CCM.0000105305.95815.91
  • Randolph, A. G., Wypij, D., Venkataraman, S. T., Hanson, J. H., Gedeit, R. G., ... & Arnold, J. H. (2002). Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial. Jama, 288(20), 2561-2568. https://doi.org/10.1001/jama.288.20.2561
  • Sandiumenge, A. (2010). Sedation of ventilated patients and analgesia. Clinical Pulmonary Medicine, 17(6), 290-299. https://doi.org/10.1097/CPM.0b013e3181fa1613
  • Sılay, F., & Akyol, A. (2017). Yoğun Bakım Ünitelerinde Sedasyon Kontrolünde Hemşirenin Rolü. Yoğun Bakım Hemşireliği Dergisi, 21(1), 28-35.
  • Staveski, S. L., Wu, M., Tesoro, T. M., Roth, S. J., & Cisco, M. J. (2017). Interprofessional team’s perception of care delivery after implementation of a pediatric pain and sedation protocol. Critical care nurse, 37(3), 66-76. https://doi.org/10.4037/ccn2017538
  • The Joanna Briggs Institute (JBI) (2017). Critical Appraisal tools for use in JBI Systematic Reviews.
  • Vet, N. J., Ista, E., de Wildt, S. N., van Dijk, M., Tibboel, D., & de Hoog, M. (2013). Optimal sedation in pediatric intensive care patients: a systematic review. Intensive care medicine, 39, 1524-1534. https://doi.org/10.1007/s00134-013-2971-3

Effect of Developed Sedo-Analgesia Monitoring Protocols on Sedation Level Monitoring in Pediatric Intensive Care Units: A Systematic Review and Meta-Analysis

Year 2025, Volume: 3 Issue: 1, 30 - 38

Özlem Sultan Dernek , Murat Bektaş

https://doi.org/10.61535/bseusbfd.1422367

Abstract

This study was conducted using systematic review and meta-analysis techniques to evaluate the effectiveness of sedo-analgesia monitoring protocols developed in pediatric intensive care units in monitoring children's sedation levels. The ages of 1 month and 18 years, were included in the study. In the analysis of the data, Hedge's g were used as effect size statistics. Four studies were included in the meta–analysis. The Cochrane Q value was found to be significant and the I2 value was 88.37%. In the random effects model, Hedges's g=-0.038 and p= 0.839. The effect of sedo-analgesia monitoring protocols developed in pediatric intensive care units on sedation monitoring may not be significant in the study.

Keywords

Pediatric Intensive Care Sedation Analgesia Sedo-Analgesia Protocol

References

  • Akkoyun, S., & Arslan, F. T. (2022). Pediatrik Anestezi Sonrası Çocukların Ağrı Düzeyleri ve Hemşirelik Girişimlerinin Değerlendirmesi: Retrospektif Tanımlayıcı Çalışma. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 11(3), 1114- 1120. https://doi.org/10.37989/gumussagbil.1138822
  • Alexander, E., Carnevale, F. A., & Razack, S. (2002). Evaluation of a sedation protocol for intubated critically ill children. Intensive and critical care Nursing, 18(5), 292-301. https://doi.org/10.1016/S0964339702000502
  • Beytut, D., & Başbakkal, Z. (2013). Çocuk Yoğun Bakımda Sedasyon Değerlendirmesi ve Konfor Skalasının Kullanımı. Yoğun Bakım Hemşireliği Dergisi, 17(2), 52-58.
  • Curley, M. A., Wypij, D., Watson, R. S., Grant, M. J. C., Asaro, L. A., ... & Matthay, M. A. (2015). Protocolized sedation vs usual care in pediatric patients mechanically ventilated for acute respiratory failure: a randomized clinical trial. Jama, 313(4), 379-389. https://doi.org/10.1001%2Fjama.2014.18399
  • Deeter, K. H., King, M. A., Ridling, D., Irby, G. L., Lynn, A. M., & Zimmerman, J. J. (2011). Successful implementation of a pediatric sedation protocol for mechanically ventilated patients. Critical care medicine, 39(4), 683-688. https://doi.org/10.1097/CCM.0b013e318206cebf Dreyfus, L., Javouhey, E., Denis, A., Touzet, S., & Bordet, F. (2017). Implementation and evaluation of a paediatric nurse- driven sedation protocol in a paediatric intensive care unit. Annals of intensive care, 7(1), 1-13. https://doi.org/10.1186/s13613-017-0256-7
  • Erden, S. (2015). Yoğun bakımda ağrı yönetiminde hemşirenin anahtar rolleri. Van Tıp Dergisi, 22(4), 332-336.
  • Erickson, S. J., Millar, J., Anderson, B. J., Festa, M. S., Straney, L., … & Long, D. A. (2020). Dexmedetomidine sedation in mechanically ventilated critically ill children: a pilot randomized controlled trial. Pediatric Critical Care Medicine, 21(9),e731-e739. https://doi.org/10.1097/PCC.0000000000002483
  • Hanser, A., Neunhoeffer, F., Hayer, T., Hofbeck, M., Schlensak, C., ... & Michel, J. (2020). A nurse‐driven analgesia and sedation protocol reduces length of PICU stay and cumulative dose of benzodiazepines after corrective surgery for tetralogy of Fallot. Journal for specialists in pediatric nursing, 25(3), e12291. https://doi.org/10.1111/jspn.12291 Ista, E., De Hoog, M., Tibboel, D., & Van Dijk, M. (2009). Implementation of standard sedation management in paediatric intensive care: effective and feasible? Journal of clinical nursing, 18(17), 2511-2520. https://doi.org/10.1111/j.1365-2702.2009.02836.x
  • Ista, E., van Dijk, M., Gamel, C., Tibboel, D., & de Hoog, M. (2008). Withdrawal symptoms in critically ill children after long-term administration of sedatives and/or analgesics: a first evaluation. Critical care medicine, 36(8), 2427- 2432. https://doi.org/10.1097/CCM.0b013e318181600d
  • Jacobi, J., Fraser, G. L., Coursin, D. B., Riker, R. R., Fontaine, D., Wittbrodt, E. T., ... & Lumb, P. D. (2002). Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Critical care medicine, 30(1), 119-141.
  • Jin, H. S., Yum, M. S., Kim, S. L., Shin, H. Y., Lee, E. H., ... & Park, S. J. (2007). The efficacy of the COMFORT scale in assessing optimal sedation in critically ill children requiring mechanical ventilation. Journal of Korean medical science, 22(4), 693-697. https://doi.org/10.3346/jkms.2007.22.4.693
  • Konateke, S., & Güngörmüş, Z. (2022). Yoğun Bakımda Ağrı, Sedasyon ve Konfor Yönetiminde Hemşirenin Rolü. Socıal Scıences Studıes Journal (SSSJournal), 4(20), 3041-3045. http://dx.doi.org/10.26449/sssj.685
  • Larson, G. E., & McKeever, S. (2018). Nurse titrated analgesia and sedation in intensive care increases the frequency of comfort assessment and reduces midazolam use in paediatric patients following cardiac surgery. Australian Critical Care, 31(1), 31-36. https://doi.org/10.1016/j.aucc.2017.02.001
  • Michel, J., Hofbeck, M., Peper, A. K., Kumpf, M., & Neunhoeffer, F. (2020). Evaluation of an updated sedation protocol to reduce benzodiazepines in a pediatric intensive care unit. Current Medical Research and Opinion, 36(1), 1-6. https://doi.org/10.1080/03007995.2019.1663689
  • Neunhoeffer, F., Kumpf, M., Renk, H., Hanelt, M., Berneck, N., ... & Hofbeck, M. (2015). Nurse‐driven pediatric analgesia and sedation protocol reduces withdrawal symptoms in critically ill medical pediatric patients. Pediatric Anesthesia, 25(8), 786-794. https://doi.org/10.1111/pan.12649
  • Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., ... & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery, 88, 105906. https://doi.org/10.1136/bmj.n71
  • Poh, Y. N., Poh, P. F., Buang, S. N. H., & Lee, J. H. (2014). Sedation guidelines, protocols, and algorithms in PICUs: a systematic review. Pediatric Critical Care Medicine, 15(9), 885-892. https://doi.org/10.1097/PCC.0000000000000255
  • Popernack, M. L., Thomas, N. J., & Lucking, S. E. (2004). Decreasing unplanned extubations: utilization of the Penn State Children’s Hospital sedation algorithm. Pediatric critical care medicine, 5(1), 58-62. https://doi.org/10.1097/01.CCM.0000105305.95815.91
  • Randolph, A. G., Wypij, D., Venkataraman, S. T., Hanson, J. H., Gedeit, R. G., ... & Arnold, J. H. (2002). Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial. Jama, 288(20), 2561-2568. https://doi.org/10.1001/jama.288.20.2561
  • Sandiumenge, A. (2010). Sedation of ventilated patients and analgesia. Clinical Pulmonary Medicine, 17(6), 290-299. https://doi.org/10.1097/CPM.0b013e3181fa1613
  • Sılay, F., & Akyol, A. (2017). Yoğun Bakım Ünitelerinde Sedasyon Kontrolünde Hemşirenin Rolü. Yoğun Bakım Hemşireliği Dergisi, 21(1), 28-35.
  • Staveski, S. L., Wu, M., Tesoro, T. M., Roth, S. J., & Cisco, M. J. (2017). Interprofessional team’s perception of care delivery after implementation of a pediatric pain and sedation protocol. Critical care nurse, 37(3), 66-76. https://doi.org/10.4037/ccn2017538
  • The Joanna Briggs Institute (JBI) (2017). Critical Appraisal tools for use in JBI Systematic Reviews.
  • Vet, N. J., Ista, E., de Wildt, S. N., van Dijk, M., Tibboel, D., & de Hoog, M. (2013). Optimal sedation in pediatric intensive care patients: a systematic review. Intensive care medicine, 39, 1524-1534. https://doi.org/10.1007/s00134-013-2971-3
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Pediatric Health and Illnesses Nursing
Journal Section Research Articles
Authors

Özlem Sultan Dernek 0000-0003-2365-2063

Murat Bektaş 0000-0003-3327-8204

Publication Date
Submission Date January 19, 2024
Acceptance Date March 23, 2024
Published in Issue Year 2025 Volume: 3 Issue: 1

Cite

APA Dernek, Ö. S., & Bektaş, M. (n.d.). Çocuk Yoğun Bakımlarda Geliştirilmiş Sedo-Analjezi İzlem Protokollerinin Sedasyon Düzeyi İzlemine Etkisi: Bir Sistematik Derleme ve Meta-Analiz. Bilecik Şeyh Edebali Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 3(1), 30-38. https://doi.org/10.61535/bseusbfd.1422367
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