Consensus guidelines on sedation and analgesia in critically ill children

Abstract

Multi-disciplinary consensus guidelines for maintenance sedation and analgesia in critically ill children have been successfully produced and are supported by levels of evidence (excluding sedation and analgesia for procedures and excluding neonates). The working group has highlighted the paucity of high-quality evidence in these important clinical areas and this emphasises the need for further randomised clinical trials in this area.

Successful Implementation of a Neonatal Pain and Sedation Protocol at 2 NICUs

“…Frequency and quality of assessments, pharmacologic therapy, duration of mechanical ventilation, and outcome were compared between baseline (12 months before implementation) and 12 months after implementation. [2][3][4][5][6][7][8][9][10][11][12][13]; P = .005), and overall staff satisfaction (physicians: 31% vs 89%; P , .001; nurses: 17% vs 55%; P , .001) increased after implementation. Time on mechanical ventilation, length of stay at the ICU, and adverse outcomes were similar before and after implementation.…”

“…International guidelines for adults [1][2][3][4] and children 5,6 recommend to titrate analgesics and sedative medication according to defined patientspecific end points. This goal is best accomplished by means of validated pain/agitation and sedation assessment using standardized scales.…”

“…We discussed the best possible practice including published evidence 1,5,[10][11][12][13][14][15][16][17][18][19][20] and our own clinical experience to develop the Vienna Protocol for Neonatal Pain and Sedation (V-PNPS) (Fig 1). The V-PNPS is a detailed protocol for the management of pain, agitation, and sedation and includes frequency of assessments, drug type, dosage, and a flowchart indicating when to use which drug according to N-PASS values.…”

A Practical Guide to Sedation and Analgesia in Paediatric Intensive Care Unit (Icu)

“…It should be initiated alongside the introduction of pharmacological interventions. Non-pharmacological interventions include reassurance, good environment (light, noise, smell), frequent communication with the patient, regular family visits, establishment of normal sleep cycles and cognitive-behavioural therapies, such as music therapy; guided imagery and relaxation therapy [9,17] .…”

“…Aetiology of the distress and choice of initial pharmacological intervention is shown in (table 1). Another important factor in deciding the agent is consideration of pharmacokinetic modifying variable, such as age, duration of action, general condition and haemodynamics, hepatic and renal function and the desired degree of sedation, etc [7,9,10] . Sedation and analgesia Goal: The ideal sedative-analgesic goal is for the patient to be awake and comfortable with minimal to no distress, however, some patients may require deeper level of sedation for optimal management (eg.…”