Nurse-Implemented Goal-Directed Strategy to Improve Pain and Sedation Management in a Pediatric Cardiac ICU

Lincoln, Patricia; Whelan, Katherine; Hartwell, Lauren P.; Dodsen, Brenda L; LaRovere, Joan; Thiagarajan, Ravi R.; Hickey, Patricia A.; Curley, Martha A. Q.

doi:10.1097/pcc.0000000000002505

Cited by 15 publications

(22 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A previous large cluster RCT conducted in 31 PICUs could not show a significant reduction of ventilator time after the implementation of nurse goal-directed sedation protocol, but intubated patients spent significantly more days awake and calm while being intubated [ 40 ]. Other studies could show a reduction of opioids and benzodiazepines [ 41 , 42 ], as well as a reduction in PICU length of stay with implementation of nurse-driven protocolized sedation [ 43 ]. Whether the use of nurse-driven sedation protocols should be implemented or not, could be debated, but the abovementioned evidence show more advantages than drawbacks with such an approach.…”

Section: Discussionmentioning

confidence: 99%

Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey

et al. 2022

View full text Add to dashboard Cite

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 frequently in high-volume PICUs (77% vs 63%, p = 0.028). First-choice drug combination was an opioid with a benzodiazepine, namely fentanyl (51%) and midazolam (71%) being the preferred drugs. The starting doses differed between PICUs from 0.1 to 5 mcg/kg/h for fentanyl, and 0.01 to 0.5 mg/kg/h for midazolam. Daily assessment and documentation for pain (81%) and sedation (87%) was reported by most of the PICUs, using the preferred validated FLACC scale (54%) and the COMFORT Behavioural scale (48%), respectively. Both analgesia and sedation were mainly monitored by nurses (92% and 84%, respectively). Eighty-six percent of the responding PICUs stated to use neuromuscular blocking agents in some scenarios. Monitoring of paralysed patients was preferably done by observation of vital signs with electronic devices support. Conclusions This survey provides an overview of current analgosedation practices among European PICUs. Drugs of choice, dosing and assessment strategies were shown to differ widely. Further research and development of evidence-based guidelines for optimal drug dosing and analgosedation assessment are needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey

et al. 2022

View full text Add to dashboard Cite

show abstract

“…19 A similar approach was trialed in a paediatric cardiac ICU and was associated with decreased opioid and benzodiazepine use without concomitant increase in other sedative drugs. 20 A trial in two neonatal ICUs found that the use of an analgesia and sedation protocol, including a standardised scoring tool, significantly increased staff satisfaction for both physicians and nurses (defined as staff feeling that pain and sedation management was "good or very good"). 4 Implementation of the protocol was associated with higher cumulative exposure to opioids, although with the majority of scoring assessments (65%) indicating that analgesia and sedation were at goal.…”

Section: Discussionmentioning

confidence: 99%

A survey of current practices in sedation, analgesia, withdrawal, and delirium management in paediatric cardiac ICUs

et al. 2023

View full text Add to dashboard Cite

Objective: To characterise the current approach to sedation, analgesia, iatrogenic withdrawal syndrome and delirium in paediatric cardiac ICUs. Design: A convenience sample survey of practitioners at institutions participating in the Pediatric Cardiac Critical Care Consortium conducted from September to December 2020. Setting: Paediatric cardiac ICUs. Measurements and main results: Survey responses were received from 33 of 42 institutions contacted. Screening for pain and agitation occurs commonly and frequently. A minority of responding centres (39%) have a written analgesia management protocol/guideline. A minority (42%) of centres have a written protocol for sedation. Screening for withdrawal occurs commonly, although triggers for withdrawal screening vary. Only 42% of respondents have written protocols for withdrawal management. Screening for delirium occurs “always” in 46% of responding centres, “sometimes” in 36% of centres and “never” 18%. Nine participating centres (27%) have written protocols for delirium management. Conclusions: Our survey identified that most responding paediatric cardiac ICUs lack a standardised approach to the management of analgesia, sedation, iatrogenic withdrawal, and delirium. Screening for pain and agitation occurs regularly, while screening for withdrawal occurs fairly frequently, and screening for delirium is notably less consistent. Only a minority of centres use written protocols or guidelines for the management of these problems. We believe that this represents an opportunity to significantly improve patient care within the paediatric cardiac ICU.

show abstract

“…37 Nurse-driven sedation protocols may standardize the use of sedation and analgesic medications. 48,49 Little research has examined the use of nonpharmacologic comfort measures and their effectiveness in reducing pain among infants after cardiac surgery; however, recent studies of massage and skin-to-skin care have demonstrated feasibility and initial evidence of pain reduction. 43,50 More research is needed to provide evidence that can inform the integration of nonpharmacologic comfort measures into nursing practice.…”

Section: Discussionmentioning

confidence: 99%

Individualized Family-Centered Developmental Care for Infants With Congenital Heart Disease in the Intensive Care Unit

LaRonde

Connor

Cerrato

et al. 2022

American Journal of Critical Care

View full text Add to dashboard Cite

Background Individualized family-centered developmental care (IFDC) is considered the standard of care for premature/medically fragile newborns and their families in intensive care units (ICUs). Such care for infants with congenital heart disease (CHD) varies. Objective The Consortium for Congenital Cardiac Care– Measurement of Nursing Practice (C4-MNP) was surveyed to determine the state of IFDC for infants younger than 6 months with CHD in ICUs. Methods An electronic survey was disseminated to 1 nurse at each participating center. The survey included questions on IFDC-related nursing practice, organized in 4 sections: demographics, nursing practice, interdisciplinary practice, and parent support. Data were summarized by using descriptive statistics. Differences in IFDC practices and IFDC-related education were assessed, and practices were compared across 3 clinical scenarios of varying infant acuity by using the χ2 test. Results The response rate was 66% (25 centers). Most respondents (72%) did not have IFDC guidelines; 63% incorporated IFDC interventions and 67% documented IFDC practices. Only 29% reported that their ICU had a neurodevelopmental team. Significant differences were reported across the 3 clinical scenarios for 11 of 14 IFDC practices. Skin-to-skin holding was provided least often across all levels of acuity. Nurse education related to IFDC was associated with more use of IFDC (P < .05). Conclusion Practices related to IFDC vary among ICUs. Opportunities exist to develop IFDC guidelines for infants with CHD to inform clinical practice and nurse education. Next steps include convening a C4-MNP group to develop guidelines and implement IFDC initiatives for collaborative evaluation.

show abstract

Nurse-Implemented Goal-Directed Strategy to Improve Pain and Sedation Management in a Pediatric Cardiac ICU

Cited by 15 publications

References 17 publications

Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey

Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey

A survey of current practices in sedation, analgesia, withdrawal, and delirium management in paediatric cardiac ICUs

Individualized Family-Centered Developmental Care for Infants With Congenital Heart Disease in the Intensive Care Unit

Contact Info

Product

Resources

About