Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals (original) (raw)
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We aim to develop evidence-based recommendations for intensivists caring for children admitted to intensive care units and requiring analgesia and sedation. A panel of national pediatric intensivists expert in the field of analgesia and sedation and other specialists (a pediatrician, a neuropsychiatrist, a psychologist, a neurologist, a pharmacologist, an anesthesiologist, two critical care nurses, a methodologist) started in 2018 a 2- years process. Three meetings and one electronic-based discussion were dedicated to the development of the recommendations (presentation of the project, selection of research questions, overview of text related to the research questions, discussion of recommendations). A telematic anonymous consultation was adopted to reach the final agreement on recommendations. A formal conflict-of-interest declaration was obtained from all the authors. Eight areas of direct interest and one additional topic were considered to identify the best available evidence an...
A Practical Guide to Sedation and Analgesia in Paediatric Intensive Care Unit (Icu)
Journal of Anesthesia and Surgery, 2017
All critically ill children have the right to adequate relief of their pain Correctable physical and environmental factors causing discomfort should be addressed using non-pharmacologic interventions before the initiation of pharmacologic interventions. The choice of sedative-analgesic agent and its initial dose are selected on the basis of several factors such as cause of the distress, desire depth and duration of therapy, clinical condition, potential drug interactions and pharmacokinetic modifying variables. Analgosedation: prioritize the use of analgesia first and then sedation should be the norm while starting sedative-analgesic and reverse to be followed in the weaning process. The level of sedation should be regularly assessed and documented using a sedation assessment scale, wherever possible using a validated scoring system such as the COMFORT scale Once the primary cause of ICU admission is treated, the sedative requirement should fall. Attempt should be made to reduce the level of sedation which require an individualised approach based on clinical condition, drug used for sedation-analgesia, total dose and duration of therapy. During reduction or withdrawal of sedative-analgesic, children should be closely observed for development of withdrawal symptoms.
Pediatric Nursing, 2006
Evaluation of pain and sedation in the PICU patient population is challenging. This article provides an overview of sedation and analgesia assessment tools developed for the critical pediatric patient who is mechanically ventilated and pharmacologically paralyzed. Studies reviewed include adult critical care, pediatric, and neonatal patients. No single tool has emerged that can adequately address pain management in the mechanically ventilated pharmacologically paralyzed pediatric patient. Nurses, as an integral part of the health care of critical pediatric patients, should endeavor to develop evidence-based methods for the evaluation of simple yet accurate scales to monitor sedation and pain in the pharmacologically paralyzed pediatric patient.
Pediatric nursing
Evaluation of pain and sedation in the PICU patient population is challenging. This article provides an overview of sedation and analgesia assessment tools developed for the critical pediatric patient who is mechanically ventilated and pharmacologically paralyzed. Studies reviewed include adult critical care, pediatric, and neonatal patients. No single tool has emerged that can adequately address pain management in the mechanically ventilated pharmacologically paralyzed pediatric patient. Nurses, as an integral part of the health care of critical pediatric patients, should endeavor to develop evidence-based methods for the evaluation of simple yet accurate scales to monitor sedation and pain in the pharmacologically paralyzed pediatric patient.
Pain Management in Neonatal Intensive Care
The Clinical Journal of Pain, 2015
Background: A pain management protocol was implemented in our neonatal intensive care unit in 2005, including individual pain assessments and pain treatment guidelines with a decision tree. Objectives: To prospectively evaluate the degree of compliance of medical and nursing staff with the pain protocol. Methods: Prospectively recorded pain scores (COMFORTneo score) and all prescribed analgesics and sedatives for the calendar year 2011 were retrieved. The primary outcome was the degree of compliance to the protocol with respect to pain assessments and treatment; the secondary outcome consisted of reasons for noncompliance. Results: Of the 732 included patients, 660 (90%) received fewer than the stipulated 3 assessments per day. Eighty-six per cent of all assessments yielded a score between 9 and 14, suggesting a comfortable patient. In cases of high pain scores (Z14), reassessment within 60 minutes took place in 31% of cases and in 40% treatment was started or adjusted. In cases of low pain scores (r8) during treatment, 13% of the 457 assessments were reassessed within 120 minutes and in 17% a dose reduction was performed. Conclusions: Although the majority of pain assessments suggested comfortable patients, there is room for improvement with respect to reassessments after adjustment of analgesic/sedative treatment. Some protocol violations such as oversedation in palliative patients are acceptable but should be well documented.
Critical Care
Background Management and monitoring of pain and sedation to reduce discomfort as well as side effects, such as over- and under-sedation, withdrawal syndrome and delirium, is an integral part of pediatric intensive care practice. However, the current state of management and monitoring of analgosedation across European pediatric intensive care units (PICUs) remains unknown. The aim of this survey was to describe current practices across European PICUs regarding the management and monitoring of pain and sedation. Methods An online survey was distributed among 357 European PICUs assessing demographic features, drug choices and dosing, as well as usage of instruments for monitoring pain and sedation. We also compared low- and high-volume PICUs practices. Responses were collected from January to April 2021. Results A total of 215 (60% response rate) PICUs from 27 European countries responded. Seventy-one percent of PICUs stated to use protocols for analgosedation management, more frequen...
Practical approach to analgesia and sedation in the neonatal intensive care unit
Seminars in Perinatology, 1998
The anatomic and physiological bases for nociception are present even in very preterm neonates. Neonates show the same behavioral, endocrine, and metabolic responses to noxious stimuli as older subjects. Preterm infants appear to be more sensitive to painful stimuli and have heightened responses to successive stimuli. Infants receiving intensive care are subjected to frequent stressful procedures and also chronic noxious influences related to the environment of care. Inflammatory conditions such as necrotizing enterocolitis may also cause pain. Untreated pain in babies is associated with increased major morbidity and mortality. Nonpharmacological interventions, including environmental modification and comforting during procedures reduce stress. Intravenous opiates are the mainstay of pharmacological analgesia. A pure sedative agent can provide physiological stability in settings in which there are less acutely painful stimuli or when there are adverse effects from, or tolerance to, opiates. Local anesthesia of skin and mucous membranes is helpful for invasive procedures. Antipyretic analgesics such as acetaminophen have a role in inflammatory pain.