2022
DOI: 10.1186/s44158-022-00036-9
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Recommendations for analgesia and sedation in critically ill children admitted to intensive care unit

Abstract: We aim to develop evidence-based recommendations for intensivists caring for children admitted to intensive care units and requiring analgesia and sedation. A panel of national paediatric intensivists expert in the field of analgesia and sedation and other specialists (a paediatrician, a neuropsychiatrist, a psychologist, a neurologist, a pharmacologist, an anaesthesiologist, two critical care nurses, a methodologist) started in 2018, a 2-year process. Three meetings and one electronic-based discussion were de… Show more

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Cited by 26 publications
(43 citation statements)
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“…Previous studies reported that benzodiazepines are independent risk factors for delirium [ 16 , 17 ]; therefore, the replacement of benzodiazepines in favour for alternative drugs like alpha-2 agonists has been advocated [ 18 ]. The recently published clinical practice guidelines for the management of Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility (PANDEM) and the Recommendations for analgesia and sedation in critically ill children admitted to intensive care unit [ 8 , 19 ] both recommend the use of alpha 2 -agonists over benzodiazepines as a first-line sedative. It has been shown that alpha 2 -agonists is a safe and benzodiazepine sparing alternative for sedation in the pediatric population [ 20 22 ].…”
Section: Discussionmentioning
confidence: 99%
“…Previous studies reported that benzodiazepines are independent risk factors for delirium [ 16 , 17 ]; therefore, the replacement of benzodiazepines in favour for alternative drugs like alpha-2 agonists has been advocated [ 18 ]. The recently published clinical practice guidelines for the management of Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility (PANDEM) and the Recommendations for analgesia and sedation in critically ill children admitted to intensive care unit [ 8 , 19 ] both recommend the use of alpha 2 -agonists over benzodiazepines as a first-line sedative. It has been shown that alpha 2 -agonists is a safe and benzodiazepine sparing alternative for sedation in the pediatric population [ 20 22 ].…”
Section: Discussionmentioning
confidence: 99%
“…It is recommended to evaluate pain regularly, we suggest every 8 h or more often in case of manifest pain and after intervention. Additionally, children under continuous analgesia and sedation can be scored using non-verbal scales in an attempt to differentiate between pain and undersedation for more appropriate intervention ( 33 ).…”
Section: Resultsmentioning
confidence: 99%
“…Protocols therefore should call for the sparing use of benzodiazepines in critically ill children, using opiates and alpha-2-agonist clonidine for firstline treatment ( 25 , 33 ). Even with our knowledge of side effects and negative long-term effects, there are still patients who are sedated using benzodiazepines.…”
Section: Resultsmentioning
confidence: 99%
“…Drugs acting on the γ-aminobutyric acid (GABA) receptor might promote a neurotoxic effect, especially in patients younger than 3 years [19,20]. Additionally, it has been found that benzodiazepines directly and dose-dependently contribute to the emergence of delirium in critically ill children [21][22][23].…”
Section: Pharmacological Agentsmentioning
confidence: 99%