Nurse titrated analgesia and sedation in intensive care increases the frequency of comfort assessment and reduces midazolam use in paediatric patients following cardiac surgery

Larson, Grace E.; McKeever, Stephen

doi:10.1016/j.aucc.2017.02.001

Cited by 16 publications

(51 citation statements)

References 43 publications

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“…It is possible that the implemented protocols directed clinicians away from midazolam use and hence is an expected result. The studies also showed that using less midazolam in the PICU was not harmful and resulted in higher success in meeting sedation targets (31) without an increase in adverse effects. Literature to support minimization of benzodiazepines is useful, as growing evidence suggests that benzodiazepines can have a negative impact on cognitive development and incidence of delirium (8,10).…”

Section: Are We Asking the Right Questions About Sedation Protocols?mentioning

confidence: 90%

“…Most studies, including the large RESTORE study (25), have shown no difference in these outcome measures (25,(27)(28)(29). The exceptions were one Korean study, which showed a decrease in duration of MV (21), and an Australian study, which demonstrated an increase in duration of MV (31). In the latter study, the authors reported a significant number of younger children in the post-implementation phase who were less likely to be extubated early post-cardiac surgery.…”

Section: What Is the Evidence For A Sedation Protocol?mentioning

confidence: 99%

“…Much of the remaining evidence regarding sedation protocols in pediatrics has come from before-and-after protocol implementation studies with different outcome measures (18,20,21,(27)(28)(29)(30)(31)(32)(33) (Table 2). Similar to the adult literature, these studies have produced mixed results with no clear benefit.…”

Section: What Is the Evidence For A Sedation Protocol?mentioning

confidence: 99%

“…Nonetheless, some benefits of sedation protocols have been shown. One positive outcome that was demonstrated in several studies was the reduction in use of benzodiazepines, midazolam in particular, with no increase in harm to patients (28,29,31,33). It is possible that the implemented protocols directed clinicians away from midazolam use and hence is an expected result.…”

Section: Are We Asking the Right Questions About Sedation Protocols?mentioning

confidence: 99%

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Sedation protocols in the pediatric intensive care unit: fact or fiction?

Balit¹,

LaRosa²,

Ong³

et al. 2021

Transl Pediatr

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Comfort of the critically unwell pediatric patient is paramount to ensuring good outcomes.Analgesia-based, multimodal sedative approaches are the foundation for comfort, whereby pain is addressed first and then sedation titrated to a predefined target based on the goals of care. Given the heterogeneity of patients within the pediatric critical care population, the approach must be individualized based on the age and developmental stage of the child, physiologic status, and degree of invasive treatment required. In both the adult and pediatric intensive care unit (PICU), sedation titration is practiced as standard of care to meet therapeutic goals with a focus on facilitating early rehabilitation and extubation while avoiding underand over-sedation. Sedation protocols have been developed as methods to reduce variability and optimize goal-directed therapy. Components of a sedation protocol include routine analgesia and sedation scoring with validated tools at specified intervals and a predefined algorithm that allows the titration of analgesia and sedation based on those assessments. Sedation protocols are designed to improve communication and documentation of sedation goals while also empowering the bedside team to respond rapidly to changes in a patient's clinical status. Previously it was thought that sedation protocols would consistently reduce duration of mechanical ventilation (MV) and length of stay (LOS) for patients in the PICU, however, this has not been the case. Nonetheless, introduction of sedation protocols has provided several benefits, including: (I) reduction in benzodiazepine usage; (II) improvements in interprofessional communication surrounding sedation goals and management of sedation goals; and (III) reductions in iatrogenic withdrawal symptoms.Successful implementation of sedation protocols requires passionate clinical champions and a robust implementation, education, and sustainability plan. Emerging evidence suggests that sedation protocols as part of a bundle of quality improvement initiatives will form the basis of future studies to improve short-and long-term outcomes after PICU discharge. In this review, we aim to define sedation protocols in the context of pediatric critical care and highlight important considerations for clinical practice and research.

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Section: Are We Asking the Right Questions About Sedation Protocols?mentioning

confidence: 90%

Section: What Is the Evidence For A Sedation Protocol?mentioning

confidence: 99%

Section: What Is the Evidence For A Sedation Protocol?mentioning

confidence: 99%

Section: Are We Asking the Right Questions About Sedation Protocols?mentioning

confidence: 99%

See 2 more Smart Citations

Sedation protocols in the pediatric intensive care unit: fact or fiction?

Balit¹,

LaRosa²,

Ong³

et al. 2021

Transl Pediatr

View full text Add to dashboard Cite

show abstract

“…7 Optimising care protocols to provide correct pain control and an optimal degree of sedation at intensive care unit (ICU) admission reduces the anxiety of children and has a positive impact on reducing the pain, distress, and discomfort of these patients. 8,9 The most commonly used strategy for managing the comfort of critically ill paediatric patients is sedation and analgesia. 3,10,11 The optimal use of analgosedation allows for invasive procedures to be carried out safely by permitting synchronisation and patient tolerance of mechanical ventilation (MV), 11 preventing accidental extubation and reducing both metabolic 12 and oxygen consumption in the case of shock.…”

Section: Introductionmentioning

confidence: 99%

Discomfort of the critically ill paediatric patient and correlated variables

Bosch-Alcaraz

Jordán

Benito-Aracil³

et al. 2020

Australian Critical Care

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Introduction: The care of critically ill children is usually invasive and aggressive, requiring numerous traumatic procedures that may cause fear, pain, and discomfort. Objectives: The aim of this study was to analyse the level of discomfort of patients admitted to the paediatric intensive care unit of a specialist children's hospital and to determine the sociodemographic and clinical variables that influence the degree of discomfort experienced by critically ill paediatric patients. Methods: We performed a descriptive observational cross-sectional study that included a total of 311 children with a median age of 5.07 y (interquartile range ¼ 0.9e11.7). A team of 10 paediatric critical care nurses assessed the degree of discomfort once for each shift (morning, afternoon, and night) on 2 successive days using the COMFORT Behavior ScaledSpanish version. Results: In total, 49.8% (n ¼ 155) of the patients were free of discomfort (score 10 points) vs. 50.2% (n ¼ 156) who experienced discomfort. There was a significant negative correlation between discomfort and the length of stay in days (Rho ¼ 0.16; p ¼ 0.02), that is, the longer the stay, the less discomfort the patient felt. The correlation between age and degree of discomfort was found to be both positive and significant (Rho ¼ 0.230, p < 0.001); the greater the age, the greater the discomfort. In comparison of all children who received analgosedation (n ¼ 205), with discomfort levels of 10.77 ± 2.94, with those who did not receive analgosedation (n ¼ 106), with discomfort levels of 11.96 ± 2.80, we did find a statistically significant difference (c 2 ¼ À4.05; p < 0.001). Conclusions: Half of the patients admitted to the paediatric intensive care unit experienced discomfort. Age and analgosedation were the two most important variables involved with a high degree of discomfort. Clinical care practices must consider these factors and try to plan activities designed to relieve discomfort in all critically ill paediatric patients.

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Safety and Monitoring During Pediatric ICU Sedation

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2020

Sedation and Analgesia for the Pediatric Intensivist

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Nurse titrated analgesia and sedation in intensive care increases the frequency of comfort assessment and reduces midazolam use in paediatric patients following cardiac surgery

Cited by 16 publications

References 43 publications

Sedation protocols in the pediatric intensive care unit: fact or fiction?

Sedation protocols in the pediatric intensive care unit: fact or fiction?

Discomfort of the critically ill paediatric patient and correlated variables

Safety and Monitoring During Pediatric ICU Sedation

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