Multidisciplinary clinical guide for analgesia and sedation; prevention of delirium and withdrawal
DOI:
https://doi.org/10.47464/MetroCiencia/vol29/1/2021/7-15Keywords:
Analgesia, sedation, delirium, withdrawal, multidisciplinary teamAbstract
The admission of a child to the PICU subdue stressful and pain stimuli. The use of analgesia and sedation is the main component for the care of the critically ill children to guarantee comfort and security. During the prescription of analgesia and sedation, monitoring of their effects is important. This process must be supervised by the health team and supported by the family.
This guide is based on the initiative “PICU liberation” where a bundle of measures (ABCDEF) is used to optimize the recovery and outcome. This guide contains tables of the pharmacology of analgesics and sedatives, some strategies on the use of analgosedation, prevention of withdrawal and delirium. A guide of the multidisciplinary team to achieve a complete adherence.
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References
Marra A, Ely EW, Pandharipande PP, et al. The ABCDEF bundle in critical care. Crit Care Clin 2017; 33:225–243.
Harris J, Ramelet AS, van Dijk M, et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: An ESPNIC position statement for healthcare professionals. Intensive Care Med 2016; 42:972–986.
Van Dijk M, de Boer JB, Koot HM, et al. The reliability and validity of the COMFORT scale as a postoperative pain instrument in 0 to 3-year-old infants. Pain 2000; 84: 367–377.
Bai J, Hsu L, Tang Y, van Dijk M. Validation of the COMFORT behavior scale and the FLACC scale for pain assessment in Chinese children after cardiac surgery. Pain Manag Nurs 2012; 13: 18–26.
Boerlage AA, Ista E, Duivenvoorden HJ, et al. The COMFORT behaviour scale detects clinically meaningful effects of analgesic and sedative treatment. Eur J Pain 2015; 19: 473–479.
Johansson M, Kokinsky E. The COMFORT behavioural scale and the modified FLACC scale in paediatric intensive care. Nurs Crit Care 2009; 14: 122–130.
Ramelet AS, Rees N, McDonald S, et al. Development and preliminary psychometric testing of the multidimensional assessment of pain scale: MAPS. Paediatr Anaesth 2007; 17: 333–340.
Keogh SJ, Long DA, Horn DV. Practice guidelines for sedation and analgesia management of critically ill children: A pilot study evaluating guideline impact and feasibility in the PICU. BMJ Open 2015; 5: e006428.
Kerson AG, DeMaria R, Mauer E, et al. Validity of the Richmond Agitation-Sedation Scale (RASS) in critically ill children. J Intensive Care 2016; 4: 65.
Cravero JP, Askins N, Sriswasdi P, et al. Validation of the Pediatric Sedation State Scale. Pediatrics 2017; 139: e20162897.
Walker T, Kudchadkar SR. Pain and Sedation Management: 2018 Update for the Rogers’ Textbook of Pediatric Intensive Care. Pediatr Crit Care Med 2019; 20: 54-61.
Kamat PP, Kudchadkar SR. IV Clonidine in the PICU: Time for Dexmedetomidine to share the limelight? Pediatr Crit Care Med 2018; 19: 792–794.
Grant MJ, Schneider JB, Asaro LA, et al. Randomized Evaluation of Sedation Titration for Respiratory Failure Study Investigators: Dexmedetomidine use in critically ill children with acute respiratory failure. Pediatr Crit Care Med 2016; 17: 1131–1141.
Venkatraman R, Hungerford JL, Hall MW, et al. Dexmedetomidine for sedation during noninvasive ventilation in pediatric patients. Pediatr Crit Care Med 2017; 18: 831–837.
Shutes BL, Gee SW, Sargel CL, et al. Dexmedetomidine as single continuous sedative during noninvasive ventilation: Typical usage, hemodynamic effects, and withdrawal. Pediatr Crit Care Med 2018; 19: 287–297.
Jenkins IA, Playfor SD, Bevan C, et al. Current United Kingdom sedation practice in pediatric intensive care. Paediatr Anaesth 2007; 17: 675–683.
Sfoggia A, Fontela PS, Moraes A, et al. Sedation and analgesia in children submitted to mechanical ventilation could be overestimated? J Pediatr (Rio J) 2003; 79: 343–348.
Fonsmark L, Rasmussen YH, Carl P. Occurrence of withdrawal in critically ill sedated children. Crit Care Med 1999; 27: 196–199.
Katz R, Kelly HW, Hsi A. Prospective study on the occurrence of withdrawal in critically ill children who receive fentanyl by continuous infusion. Crit Care Med 1994; 22: 763–767.
Sanchez-Pinto LN, Nelson LP, Lieu P, et al. Implementation of a risk stratified opioid weaning protocol in a pediatric intensive care unit. J Crit Care 2018; 43:214–219.
Robertson RC, Darsey E, Fortenberry JD, et al. Evaluation of an opiate-weaning protocol using methadone in pediatric intensive care unit patients. Pediatr Crit Care Med 2000; 1:119–123.
Franck LS, Harris SK, Soetenga DJ, et al. The withdrawal assessment tool-1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Pediatr Crit Care Med 2008; 9: 573–580.
Franck LS, Scoppettuolo LA, Wypij D, et al. Validity and generalizability of the withdrawal assessment tool-1 (WAT-1) for monitoring iatrogenic withdrawal syndrome in pediatric patients. Pain 2012; 153: 142–148.
Ista E, van Dijk M, de Hoog M, et al. Construction of the Sophia observation withdrawal symptoms-scale (SOS) for critically ill children. Intensive Care Med 2009; 35: 1075–1081.
Ista E, de Hoog M, Tibboel D, et al. Psychometric evaluation of the Sophia observation withdrawal symptoms scale in critically Ill children. Pediatr Crit Care Med 2013; 14: 761–769.
Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2018; 46: e825-e840.
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Copyright (c) 2021 Rocío Yerovi, Paola Pico Aguilar, Susana Espinoza, Martha Cuñas, Santiago Espinosa, Gabriela Arévalo, Francisco Espinel, Santiago Campos-Miño

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