Parent’s experiences of their child’s withdrawal syndrome: a driver for reciprocal nurse-parent partnership in withdrawal assessment

Craske, Jennie; Carter, Bernie; Jarman, Ian H.; Tume, Lyvonne N

doi:10.1016/j.iccn.2018.09.001

Cited by 10 publications

(15 citation statements)

References 37 publications

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“…Assessment of IWS, as we observed, is more common PICU practice with only two validated tools (28, 29); however, it is rarely studied in adults and thus not part of the ABCDEF bundle (30). The presence of IWS is stressful for the critically ill child and their parents (31) and leads to prolonged hospital stay and increased healthcare costs (32); thus, addition of IWS to the ABCDEF bundle must be considered particularly for pediatrics. We also found that sedation protocols were implemented in daily practice in half of PICUs.…”

Section: Discussionmentioning

confidence: 99%

ABCDEF Bundle Practices for Critically Ill Children: An International Survey of 161 PICUs in 18 Countries*

Ista

Redivo

Kananur

et al. 2021

Critical Care Medicine

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MEASUREMENTS AND MAIN RESULTS:Of the 161 participating PICUs, 83% were in academic teaching hospitals and 42% were in free-standing children's hospitals. Median size was 16 beds (interquartile range, 10-24 beds). Only 15 PICUs (9%) had incorporated all six ABCDEF bundle components into routine practice. Standardized pain assessment (A) was the most common (91%), followed by family engagement (F, 88%) and routine sedation assessment (C) with validated scales (84%). Protocols for testing extubation readiness or conducting spontaneous breathing trials (B) were reported in 57%, with 34% reporting a ventilator weaning protocol. Routine delirium monitoring with a validated screening tool (D) was reported by 44% of PICUs, and 26% had a guideline, protocol, or policy for early exercise/mobility (E). Practices for spontaneous breathing trials were variable in 29% of Canadian PICUs versus greater than 50% in the other regions. Delirium monitoring was lowest in Brazilian PICUs (18%) versus greater than 40% in other regions, and family engagement was reported in 55% of European PICUs versus greater than 90% in other regions. CONCLUSIONS: ABCDEF bundle components have been adopted with substantial variability across regions. Additional research must rigorously evaluate the efficacy of specific elements with a focus on B, D, E, and full ABCDEF bundle implementation. Implementation science is needed to facilitate an understanding of the barriers to ABCDEF implementation and sustainability with a focus on specific cultural and regional differences.

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Section: Discussionmentioning

confidence: 99%

ABCDEF Bundle Practices for Critically Ill Children: An International Survey of 161 PICUs in 18 Countries*

Ista

Redivo

Kananur

et al. 2021

Critical Care Medicine

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“…The comfort provided to families will enhance a better understanding of their child's behavior and prospectively contribute to the success of analgo-sedative pain assessment and management plans. 36 In future, artificial intelligence (AI) may also emerge as a useful technology to improve the evaluation and management of neonatal analgesic and sedative use. AI can potentially reduce the manual workload of collecting subjective information intermittently through the continuous retrieval of data through the use of AI leading to improved recognition and management of neonatal analgo-sedative requirements Even though there is limited information available concerning IWS epidemiology specifically for the neonatal group, data from the general pediatric population shows high prevalence and incidence rates for this problem particularly when drug exposure lasts more than 5 days.…”

Section: Preventionmentioning

confidence: 99%

Section: Preventionmentioning

confidence: 99%

Iatrogenic Withdrawal Syndrome in Critically Ill Neonates: A Review of Mechanisms, Assessment, Management, and Prevention

Santos

Peano

Soares

et al. 2022

J Pediatr Intensive Care

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Considering that neonatal pain is a relevant matter given its implications and consequences, many neonates, particularly those undergoing critical care, are subjected to analgo-sedation therapies, which commonly includes treatment with opioids and benzodiazepines. These drugs, however, can induce tolerance and dependency, leading to the development of the so-called iatrogenic withdrawal syndrome (IWS) which is observed following discontinuation of these therapeutic agents particularly when utilized for a prolonged period of time (≥5 days). IWS consists of signs and symptoms manifested especially in young children, such as term and premature newborns in the neonatal intensive care unit, who are less capable of metabolizing and eliminating these drugs, compared with older patients. In this study, we review assessment tools that were developed to identify, evaluate, and manage children affected by IWS. The studies reviewed demonstrate that optimal management of IWS includes consideration of alternate routes of drug administration, the need for adequate time for drug tapering, and also the presence of planned rescue therapy when encountering cases refractory to ongoing management. Equally important is prevention of IWS which can be accomplished with the implementation of drug rotation protocols and, adherence to evidenced-based guidelines which facilitate an overall decline in the use and duration of opioids and benzodiazepines. Finally, our review strongly supports the need for more research on IWS in neonates given their increased susceptibility and sparse published data for this age group.

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“…This will help center the patient/family as partners in care, mitigate anxiety and psychological stress, and allow them to participate in identifying symptoms of iatrogenic withdrawal. 14…”

Section: Components Of a Sedation Weaning Strategymentioning

confidence: 99%

Weaning Analgosedation in Patients Requiring Prolonged Mechanical Ventilation

Taylor

Hammer

Taylor

2021

J Intensive Care Med

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Although research supports the minimization of sedation in mechanically ventilated patients, many patients with severe acute respiratory distress syndrome (ARDS) receive prolonged opioid and sedative infusions. ICU teams face the challenge of weaning these medications, balancing the risks of sedation with the potential to precipitate withdrawal symptoms. In this article, we use a clinical case to discuss our approach to weaning analgosedation in patients recovering from long-term mechanical ventilation. We believe that a protocolized, multimodal weaning strategy implemented by a multidisciplinary care team is required to reduce potential harm from both under- and over-sedation. At present, there is no strong randomized clinical trial evidence to support a particular weaning strategy in adult ICU patients, but appraisal of the existing literature in adults and children can guide decision-making to enhance the recovery of these patients.

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Parent’s experiences of their child’s withdrawal syndrome: a driver for reciprocal nurse-parent partnership in withdrawal assessment

Abstract: Facilitating nurse-parent collaboration in withdrawal assessment may have reciprocal benefits by moderating parental stress and aiding the assessment and management of withdrawal syndrome.

Cited by 10 publications

References 37 publications

ABCDEF Bundle Practices for Critically Ill Children: An International Survey of 161 PICUs in 18 Countries*

ABCDEF Bundle Practices for Critically Ill Children: An International Survey of 161 PICUs in 18 Countries*

Iatrogenic Withdrawal Syndrome in Critically Ill Neonates: A Review of Mechanisms, Assessment, Management, and Prevention

Weaning Analgosedation in Patients Requiring Prolonged Mechanical Ventilation

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