Nurse‐driven pediatric analgesia and sedation protocol reduces withdrawal symptoms in critically ill medical pediatric patients

Neunhoeffer, Felix; Kumpf, Matthias; Renk, Hanna; Hanelt, Malte; Berneck, Nicole; Bosk, Axel; Gerbig, Ines; Heimberg, Ellen; Hofbeck, Michael

doi:10.1111/pan.12649

Cited by 59 publications

(72 citation statements)

References 33 publications

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“…The median age of the population in each period was 2 and 3 years, respectively, which is similar to that of other studies [15, 18]. The mortality rate in our study population (17%) was higher than in our overall PICU population (5%).…”

Section: Discussionsupporting

confidence: 89%

“…All recent large-cohort studies chose duration of mechanical ventilation as the primary outcome, but none were able to show a significant reduction in mechanical ventilation [15–18]. Except for the study by Curley et al, which was a randomised, controlled trial in children with ARDS, the other studies were designed as prospective or retrospective before and after studies.…”

Section: Discussionmentioning

confidence: 99%

“…After implementation of a nurse-driven sedation protocol, Keogh et al [17] showed a reduction in the duration of morphine administration of 19 h, and Neunhoeffer et al [15] described a significant reduction in benzodiazepine cumulative doses after application of the protocol. Deeter et al [16] compared patients treated under a nurse-driven protocol to a historic cohort and highlighted that the protocol enabled the duration of sedative drugs to be reduced from 7 to 5 days.…”

Section: Discussionmentioning

confidence: 99%

“…The WAT-1 score is now used routinely in our PICU to detect occurrences of withdrawal [25, 26]. In their before and after study design including 165 and 172 patients, respectively, Neunhoeffer et al [15] showed that the use of a sedation protocol enabled significant reductions in the incidence of withdrawal symptoms from 23.6% before and 12.8% after implementing the protocol ( p = 0.005). In our population, withdrawal symptoms tended to decrease without reaching significance.…”

Section: Discussionmentioning

confidence: 99%

“…Nurse-driven sedation and analgesia protocols were evaluated in adults and, despite interesting results [11–13], a Cochrane review in 2015 concluded that there was insufficient evidence to evaluate the effectiveness of protocol-directed sedation [14]. In paediatric units, goal-directed sedation protocols were also developed but few studies were found in the literature, with unclear results [15–17]. Recently, a randomised controlled trial among children admitted in PICU for acute lung injury showed no difference in duration of ventilation regardless of sedation protocol or usual care implementation [18].…”

Section: Introductionmentioning

confidence: 99%

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Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit

Dreyfus

Javouhey

Denis

et al. 2017

Ann. Intensive Care

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BackgroundOptimal sedation and analgesia is a challenge in paediatric intensive care units (PICU) because of difficulties in scoring systems and specific metabolism inducing tolerance and withdrawal. Excessive sedation is associated with prolonged mechanical ventilation and hospitalisation. Adult and paediatric data suggest that goal-directed sedation algorithms reduce the duration of mechanical ventilation. We implemented a nurse-driven sedation protocol in a PICU and evaluated its impact.MethodsWe conducted a before and after protocol implementation study in a population of children aged 0–18 years who required mechanical ventilation for at least 24 h between January 2013 and March 2015. After the protocol implementation in January 2014, nurses managed analgesia and sedation following an algorithm that included the COMFORT behaviour scale (COMFORT-B). Duration of mechanical ventilation was the primary outcome; secondary outcomes were total doses and duration of medications, PICU length of stay, incidence of ventilator-associated pneumonia, and occurrence of withdrawal symptoms. Pre–post analysis followed with segmented regression analysis of interrupted time series was used to assess the effect of protocol.ResultsA total of 200 children were analysed, including 107 before implementation and 93 children after implementation of the protocol. After implementation of the protocol, the total number of COMFORT-B scores per day of mechanical ventilation significantly increased from 3.9 ± 2.5 times during the pre-implementation period to 6.6 ± 3.5 times during the post-implementation period (p < 10−3). Mean duration of mechanical ventilation tended to be lower in the post-implementation period (8.3 ± 7.3 vs 6.6 ± 5.6 days, p = 0.094), but changes in either the trend per trimester from pre-implementation to post-implementation (p = 0.933) or the immediate change after implementation (p = 0.923) were not significant with segmented regression analysis. No significant change between pre- and post-implementation was shown for total dose of sedatives, withdrawal symptoms, agitation episodes, or unplanned endotracheal extubations.ConclusionsThese results were promising and suggested that implementation of a nurse-driven sedation protocol in a PICU was feasible. Evaluation of sedation and analgesia was better after the protocol implementation; duration of mechanical ventilation and occurrence of withdrawal symptoms tended to be reduced.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0256-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit

Dreyfus

Javouhey

Denis

et al. 2017

Ann. Intensive Care

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Drug withdrawal: prevention and management

Saul¹

2023

The Great Ormond Street Hospital Manual of Children and Young People's Nursing Practices

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Analgesics and Sedatives in Critically Ill Newborns and Infants: The Impact on Long‐Term Neurodevelopment

Schiller

Allegaert

Hunfeld

et al. 2018

The Journal of Clinical Pharma

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Inadequate pain and/or stress management in preterm‐ and term‐born infants has been associated with increased morbidity and even mortality. However, exposure to analgosedatives during early infancy may also be one of the risk factors for subsequent neurodevelopmental impairment, at least in animal studies. Because infants admitted to neonatal or pediatric intensive care units may receive high amounts of these drugs for prolonged periods of time and the majority of these infants nowadays survive to discharge, this is of major concern. A balanced approach that incorporates the assessment and quantification of both wanted effects as well as unwanted side effects is therefore needed. In this article, the optimal dose determination of commonly used analgosedative drugs as well as their potential long‐term effects on the developing human brain and neuropsychological functioning are reviewed.

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Nurse‐driven pediatric analgesia and sedation protocol reduces withdrawal symptoms in critically ill medical pediatric patients

Abstract: Implementation of a nurse-driven pASP reduced the total dose of benzodiazepines and the occurrence of withdrawal symptoms significantly.

Cited by 59 publications

References 33 publications

Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit

Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit

Drug withdrawal: prevention and management

Analgesics and Sedatives in Critically Ill Newborns and Infants: The Impact on Long‐Term Neurodevelopment

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