Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals

Harris, Jonathan D.; Ramelet, Anne‐Sylvie; Dijk, Monique van; Pokorná, Pavla; Wielenga, Joke M.; Tume, Lyvonne N.; Tibboel, Dick; Ista, Erwin

doi:10.1007/s00134-016-4344-1

Cited by 332 publications

(401 citation statements)

References 94 publications

(106 reference statements)

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“…The main indications to these medications are: to better manage pain, anxiety, and agitation; promote amnesia; facilitate synchrony with the mechanical ventilation; avoid loss of catheters and endotracheal tube; and reduce cellular metabolism. [1][2][3][4] However, in spite of helping to manage these conditions, it is still difficult to reach adequate level of sedation and analgesia, avoiding excesses and subdose. An ideal level of sedation is described as an estate on which the patient is sleepy, responding to environmental stimuli, without risks and excessive movements.…”

Section: Introductionmentioning

confidence: 99%

“…For better management of these patients, the use of scales and protocols of analgesia and sedation, associated with mild sedation and daily interruption, is associated with lower use and shorter duration of sedation, mechanical ventilation, and length of hospital and ICU stay (as described by the Society of Critical Care Medicine -SCCM). [1][2][3][4] oBJective The objective is to review the main aspects of sedation and analgesia in pediatric intensive care units, including the use of scales for patient management, daily interruption, adequate level of sedation, abstinence syndrome, and delirium. In the end, to promote the use of protocols, with the main aspects to lower the use of sedatives through the use of sedation and analgesia scales, improving multidisciplinary communication and lowering hospital and length of ICU stay.…”

Section: Introductionmentioning

confidence: 99%

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Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Motta

Luglio²,

Delgado

et al. 2016

Rev. Assoc. Med. Bras.

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Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Motta

Luglio²,

Delgado

et al. 2016

Rev. Assoc. Med. Bras.

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“…This is further complicated by recent concerns regarding the adverse effects of sedation (particularly deep sedation [3]) and analgesia in both adult [4] and paediatric patients. Thus this is a very difficult area of medicine to get right-steering between the Scylla of deep sedation and opiate comas on the one hand, and the Charybdis of pain, agitation and the chronic sequelae of these on the other.In a recent article in Intensive Care Medicine, a multidisciplinary group of experts from the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) have reviewed the literature relating to the assessment and management of pain, anxiety, withdrawal and delirium in critically ill children and neonates [5]. The authors have provided a comprehensive summary of the relevant literature and recommended scoring tools based on 32 manuscripts (after screening 1151) pertaining to 15 recommended assessment tools.…”

mentioning

confidence: 99%

“…In a recent article in Intensive Care Medicine, a multidisciplinary group of experts from the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) have reviewed the literature relating to the assessment and management of pain, anxiety, withdrawal and delirium in critically ill children and neonates [5]. The authors have provided a comprehensive summary of the relevant literature and recommended scoring tools based on 32 manuscripts (after screening 1151) pertaining to 15 recommended assessment tools.…”

mentioning

confidence: 99%

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Mind over matter? Pain, withdrawal and sedation in paediatric critical care

2016

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Is your paediatric intensive care (PICU) patient free of pain, comfortable and calm? The answer to this seemingly innocuous question may not be straightforward. Recognition and management of pain in intensive care units (ICUs) is challenging because of the many exacerbating and confounding factors that exist in this setting. Adding to this complexity may be misconceptions which relate to patient perception and capacity, the healthcare system and the clinicians themselves [1]. Clinician-associated barriers to adequate pain relief in ICU patients include knowledge deficits, low prioritization, failure to assess, acknowledge or evaluate treatment effects, plus attitudes and biases related to pain relief and communication difficulties.Nearly 50 % of adult patients report experiencing moderate to severe pain during their ICU stay [1]. In adults, inadequate pain relief with persistent pain has profound short-and long-term consequences, including negative physiological and psychological impacts, which in turn affect socio-economic health. Alarmingly, children are even less likely to receive appropriate analgesia than adults [2]. This is further complicated by recent concerns regarding the adverse effects of sedation (particularly deep sedation [3]) and analgesia in both adult [4] and paediatric patients. Thus this is a very difficult area of medicine to get right-steering between the Scylla of deep sedation and opiate comas on the one hand, and the Charybdis of pain, agitation and the chronic sequelae of these on the other.In a recent article in Intensive Care Medicine, a multidisciplinary group of experts from the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) have reviewed the literature relating to the assessment and management of pain, anxiety, withdrawal and delirium in critically ill children and neonates [5]. The authors have provided a comprehensive summary of the relevant literature and recommended scoring tools based on 32 manuscripts (after screening 1151) pertaining to 15 recommended assessment tools. The recommended scoring systems come with the advantages of some standardization and formalization of review processes-these may be particularly helpful for less experienced staff.The need for standardization has been highlighted in studies in other areas, such as in accident and emergency departments where knowledge, biases (e.g. sex, racial [6], age, opiophobia, etc.) and emergency department culture itself were identified as variables that influenced provision of adequate analgesia [7].However, the use of assessment scores has not been entirely validated as a means of improving the quality of care of pain, anxiety and distress. Added to this we know that parental attitudes towards pain differ [8] and there is discordance between self reports and behavioural pain measures following surgery in 3-to 7-year-olds [9], raising questions about the applicability of behavioural scales as sole measures of pain intensity in younger children. A recent review on pain management in children in the em...

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Neuroleptics for Delirium: More Research Is Needed

Bogman

Schieveld

2017

JAMA Intern Med

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Heat-not-burn tobacco products are for sale around the world. Although they are not yet on the market in the United States, Phillip Morris International has applied to the US Food and Drug Administration (FDA) to sell these products. These products threaten the progress that has been made on decreasing the harms of second-hand smoke because existing bans may not apply to these heat-not-burn products. However, as convincingly reported by Auer and colleagues, 1 although these products may or may not produce smoke, they release cancer-causing chemicals. As shown in their table, heat-not-burn cigarettes release similar levels of many volatile organic compounds and nicotine as conventional cigarettes and higher levels of the polycyclic aromatic hydrocarbon acenaphthene than conventional cigarettes. They are bad for health because they release cancer-causing chemicals, and I hope the FDA will not approve them for that important reason. If the FDA does approve the sale of these products, existing smoking bans should be amended to include these products.

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Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals

Cited by 332 publications

References 94 publications

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Mind over matter? Pain, withdrawal and sedation in paediatric critical care

Neuroleptics for Delirium: More Research Is Needed

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