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Síndrome de abstinencia en Cuidados Intensivos Pediatricos Incidencia y factores de riesgo

, : Síndrome de abstinencia en Cuidados Intensivos Pediatricos Incidencia y factores de riesgo.

Conocer la incidencia de s ndrome de abstinencia tras perfusi n prolongada de fentanilo y midazolam en ni os, y los factores de riesgo asociados. Estudio de cohorte hist rica o retrospectiva. UCI pedi trica de seis camas de un hospital universitario. Se incluyen 48 pacientes pedi tricos que recibieron sedoanalgesia en perfusi n continua con midazolam y fentanilo exclusivamente, durante al menos 48 horas. Ninguna. Se recogen datos cl nicos y demogr ficos, dosis y duraci n de sedoanalgesia recibida, aparici n de s ndrome de abstinencia, gravedad y tratamiento del mismo. El 50% desarroll s ndrome de abstinencia. Hubo diferencias significativas entre los que lo desarrollaron y los que no en cuanto a duraci n del tratamiento previo y dosis acumulada de ambos f rmacos. Una dosis acumulada de fentanilo de 0,48mg/kg o de midazolam de 40mg/kg, y una duraci n de la perfusi n de ambos de 5,75 d as fueron factores de riesgo para el desarrollo de abstinencia. La mayor a present un cuadro leve o moderado, que comenz a las 12-36 horas de suspender la perfusi n. El f rmaco m s utilizado en el tratamiento fue la metadona. La incidencia de s ndrome de abstinencia en ni os tras perfusi n prolongada de midazolam y fentanilo es elevada. El desarrollo del s ndrome se relaciona con tiempos de perfusi n prolongados y con dosis acumuladas elevadas de ambos f rmacos. To determine the incidence of withdrawal syndrome after prolonged infusion of fentanyl and midazolam in children, and the associated risk factors. Historic or retrospective cohort study. Pediatric Intensive Care Unit in an academic center. Forty-eight pediatric patients who received sedation and analgesia only with fentanyl and midazolam through continuous infusion for at least 48hours. None. Collected data included demographic and clinical parameters, dose and duration of sedation received, and incidence, severity and treatment of withdrawal syndrome. 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 withdrawal. 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.


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