Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

Lucas, Sarah Scarpace; Nasr, Viviane G.; Ng, Angelica J.; Joe, Charlene; Bond, Meredyth; DiNardo, James A.

doi:10.1097/pcc.0000000000000619

Cited by 37 publications

(20 citation statements)

References 97 publications

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“…In our experience, the use of medications that lower the vascular tone and resistance were associated with severe cyanosis and shunt thrombosis. 8 9 15…”

Section: Resultsmentioning

confidence: 99%

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Procedural Sedation in Congenital Heart Disease

Al-Jureidini

Patel³

et al. 2023

J Pediatr Intensive Care

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Procedural sedation in patients with congenital heart disease (CHD) is associated with significant morbidity and mortality. It is vital for the practitioner to fully understand the complexity of lesions, their hemodynamics, and the impact of medications commonly used for procedural sedation on the stability of systemic vascular resistance and pulmonary flow. According to the literature, we explain the interaction of the systemic vascular resistance and pulmonary flow in such lesions and divide them into five categories outlined in this article: (1) CHDs with left-to-right shunt with normal pulmonary arterial pressure and resistance, (2) CHD with left-to-right shunt and moderate to severe elevation of pulmonary arterial pressure with near-normal pulmonary vascular resistance, (3) CHD with pulmonary flow dependent on systemic vascular resistance, (4) patients with congenital coronary stenosis and coronary anomalies, and 5) aortic obstructive lesions.

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“…In our experience, the use of medications that lower the vascular tone and resistance were associated with severe cyanosis and shunt thrombosis. 8 9 15…”

Section: Resultsmentioning

confidence: 99%

“…Some sedatives have similar effects to prostaglandins on the systemic and pulmonary circulation and should be avoided. 8 9 15 In such cases, we recommend initiation of alpha agonists (phenylephrine) concomitantly with prostaglandin E1 and prior to initiation of sedation.…”

Section: Resultsmentioning

confidence: 99%

Procedural Sedation in Congenital Heart Disease

Al-Jureidini

Patel³

et al. 2023

J Pediatr Intensive Care

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“… 7 8 The recent consensus statement by Lucas et al describes the pharmacotherapies currently available to manage pain and sedation in paediatric cardiac critical care patients and summarises dosing recommendations from available literature. 13 Lucas and colleagues conclude that a more individualised analgesic and sedative treatment strategy is necessary to provide optimal care without adverse effects resulting from pharmacotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…A recent review by Lucas et al 13 on pharmacotherapies in paediatric cardiac critical care provides an extensive overview of PK of analgesic and sedative drugs used in children after cardiac surgery but focused less on their use in protocols for clinical practice. Changes in clearance and volume of distribution (PK) and/or PD due to the use of cardiopulmonary bypass (CPB), disease processes, low cardiac output syndrome, surgical procedure and age may alter optimal way of dosing analgesics and sedatives in children after cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

An international survey of management of pain and sedation after paediatric cardiac surgery

Zeilmaker-Roest

Wildschut

Dijk

et al. 2017

bmjpo

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ObjectiveThe mainstay of pain treatment after paediatric cardiac surgery is the use of opioids. Current guidelines for its optimal use are based on small, non-randomised clinical trials, and data on the pharmacokinetics (PK) and pharmacodynamics (PD) of opioids are lacking. This study aims at providing an overview of international hospital practices on the treatment of pain and sedation after paediatric cardiac surgery.DesignA multicentre survey study assessed the management of pain and sedation in children aged 0–18 years after cardiac surgery.SettingPediatric intensive care units (PICU)of 19 tertiary children’s hospitals worldwide were invited to participate. The focus of the survey was on type and dose of analgesic and sedative drugs and the tools used for their pharmacodynamic assessment.ResultsFifteen hospitals (response rate 79%) filled out the survey. Morphine was the primary analgesic in most hospitals, and its doses for continuous infusion ranged from 10 to 60 mcg kg-1 h-1 in children aged 0–36 months. Benzodiazepines were the first choice for sedation, with midazolam used in all study hospitals. Eight hospitals (53%) reported routine use of sedatives with pain treatment. Overall, type and dosing of analgesic and sedative drugs differed substantially between hospitals. All participating hospitals used validated pain and sedation assessment tools.ConclusionThere was a large variation in the type and dosing of drugs employed in the treatment of pain and sedation after paediatric cardiac surgery. As a consequence, there is a need to rationalise pain and sedation management for this vulnerable patient group.

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“…2 Consensus guidelines, at present, acknowledge the lack of high-quality evidence on which to base practice recommendations for sedation. [3][4][5][6][7][8] This lack of evidence has resulted in heterogeneous approaches to management [9][10][11] and widespread off-label sedative use across paediatric intensive care units (PICUs). [12][13][14][15] For example, a recent systematic review 16 found that optimal sedation was only achieved in little over half (57.6%) of the time.…”

Section: Introductionmentioning

confidence: 99%

Design and reporting characteristics of clinical trials investigating sedation practices in the paediatric intensive care unit: a scoping review by SCEPTER (Sedation Consortium on Endpoints and Procedures for Treatment, Education and Research)

et al. 2021

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ObjectivesTo conduct a scoping review of sedation clinical trials in the paediatric intensive care setting and summarise key methodological elements.DesignScoping review.Data sourcesPubMed, Embase, Cumulative Index to Nursing and Allied Health Literature and grey references including ClinicalTrials.gov from database inception to 3 August 2021.Study selectionAll human trials in the English language related to sedation in paediatric critically ill patients were included. After title and abstract screening, full-text review was performed. 29 trials were eligible for final analysis.Data extractionA coding manual was developed and pretested. Trial characteristics were double extracted.ResultsThe majority of trials were single centre (22/29, 75.9%), parallel group superiority (17/29, 58.6%), double-blinded (18/29, 62.1%) and conducted in an academic setting (29/29, 100.0%). Trial enrolment (≥90% planned sample size) was achieved in 65.5% of trials (19/29), and retention (≥90% enrolled subjects) in 72.4% of trials (21/29). Protocol violations were reported in nine trials (31.0%). The most commonly studied cohorts were mechanically ventilated patients (28/29, 96.6%) and postsurgical patients (11/29, 37.9%) with inclusion criteria for age ranging from 0±0.5 to 15.0±7.3 years (median±IQR). The median age of enrolled patients was 1.7 years (IQR=4.4 years). Patients excluded from trials were those with neurological impairment (21/29, 72.4%), complex disease (20/29, 69.0%) or receipt of neuromuscular blockade (10/29, 34.5%). Trials evaluated drugs/protocols for sedation management (20/29, 69.0%), weaning (3/29, 10.3%), daily interruption (3/29, 10.3%) or protocolisation (3/29, 10.3%). Primary outcome measures were heterogeneous, as were assessment instruments and follow-up durations.ConclusionsThere is substantial heterogeneity in methodological approach in clinical trials evaluating sedation in critically ill paediatric patients. These results provide a basis for the design of future clinical trials to improve the quality of trial data and aid in the development of sedation-related clinical guidelines.

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Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

Cited by 37 publications

References 97 publications

Procedural Sedation in Congenital Heart Disease

Procedural Sedation in Congenital Heart Disease

An international survey of management of pain and sedation after paediatric cardiac surgery

Design and reporting characteristics of clinical trials investigating sedation practices in the paediatric intensive care unit: a scoping review by SCEPTER (Sedation Consortium on Endpoints and Procedures for Treatment, Education and Research)

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