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pain and sedation assessment in critically ill children

Alicia G Kachmar, Sharon Y Irving, Cynthia A Connolly, Martha A Q Curley
OBJECTIVES: To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness. DATA SOURCES: For this systematic review, we searched the Cochrane Library, Scopus, PubMed, Ovid, Embase, and CINAHL databases from January 1960 to March 2017. STUDY SELECTION: Included were studies with subjects 3-18 years old at the time of post PICU follow-up evaluation and use of an objective standardized neuropsychologic test with at least one cognitive functioning dimension...
March 2018: Pediatric Critical Care Medicine
Benedicta Tabacco, Claudio Tacconi, Angela Amigoni
BACKGROUND: Admission in Pediatric Intensive Care Unit requires management and monitoring of analgesia and sedation, in order to reduce their adverse effects, and to prevent withdrawal syndrome and delirium. The aim of this study was to evaluate the management of analgesia and sedation in critically ill children admitted in the Italian Pediatric Intensive Care Units. METHODS: For this survey we have submitted a telematics questionnaire to 24 nursing coordinators of the Pediatric Intensive Care Units or Neonatal Intensive Care Units admitting critically ill children...
October 2017: Minerva Anestesiologica
Ahmad Ismail
Providing effective pain management is necessary for all patients in the intensive care unit (ICU). Because of developmental considerations, caring for children may provide additional challenges. The purpose of this literature review is to describe key challenges in providing effective pain management in pediatric intensive care units (PICUs), with the aim of bringing about a better understanding by health care providers caring for children. Challenges of providing effective pain management in the PICU can be categorized into four levels...
December 2016: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Julia Harris, Anne-Sylvie Ramelet, Monique van Dijk, Pavla Pokorna, Joke Wielenga, Lyvonne Tume, Dick Tibboel, Erwin Ista
BACKGROUND: This position statement provides clinical recommendations for the assessment of pain, level of sedation, iatrogenic withdrawal syndrome and delirium in critically ill infants and children. Admission to a neonatal or paediatric intensive care unit (NICU, PICU) exposes a child to a series of painful and stressful events. Accurate assessment of the presence of pain and non-pain-related distress (adequacy of sedation, iatrogenic withdrawal syndrome and delirium) is essential to good clinical management and to monitoring the effectiveness of interventions to relieve or prevent pain and distress in the individual patient...
June 2016: Intensive Care Medicine
Andrew Singleton, Robert J Preston, Amalia Cochran
The objective of this study was to assess current practice patterns and attitudes toward pediatric sedation and analgesia in United States (US) burn centers for critically ill patients. Survey-based questionnaire was sent to 119 Directors at US burn centers that care for pediatric patients. Forty-one surveys (34%) were analyzed. 48.8% of responding centers mandate pediatric consultation for pediatric burn patients based on factors such as age and burn size. The most common sedation and analgesic agents used were midazolam, fentanyl, morphine, ketamine, and diphenhydramine...
May 2015: Journal of Burn Care & Research: Official Publication of the American Burn Association
M J Solana, J Lopez-Herce, S Fernandez, R Gonzalez, J Urbano, J Lopez, J M Bellon
PURPOSE: The purpose of this study is to assess the usefulness and accuracy of skin conductance (SC) as a tool to evaluate the level of sedation and pain in pediatric critical patients during painful procedures and to compare it with hemodynamic variables, clinical scales, and bispectral index (BIS). MATERIALS AND METHODS: This is a prospective observational study in 61 critical children undergoing invasive procedures. Hemodynamic data (heart rate and arterial blood pressure), clinical scales punctuation (Ramsay, COMFORT, and numeric rating pain scales), BIS, and the number of fluctuations of SC per second were collected before, during, and at the end of the procedure...
June 2015: Journal of Critical Care
Martha A Q Curley, David Wypij, R Scott Watson, Mary Jo C Grant, Lisa A Asaro, Ira M Cheifetz, Brenda L Dodson, Linda S Franck, Rainer G Gedeit, Derek C Angus, Michael A Matthay
IMPORTANCE: Protocolized sedation improves clinical outcomes in critically ill adults, but its effect in children is unknown. OBJECTIVE: To determine whether critically ill children managed with a nurse-implemented, goal-directed sedation protocol experience fewer days of mechanical ventilation than patients receiving usual care. DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized trial conducted in 31 US pediatric intensive care units (PICUs)...
January 27, 2015: JAMA: the Journal of the American Medical Association
A A Boerlage, E Ista, H J Duivenvoorden, S N de Wildt, D Tibboel, M van Dijk
BACKGROUND: The COMFORT behaviour scale (COMFORT-B scale) is widely used in paediatric intensive care units to assess young children's pain and distress. It is also used to assess the impact of treatment interventions, but little is known on the scale's sensitivity to detect changes between before and after measurements following an intervention. This study explored the sensitivity to change of the COMFORT-B scale. METHODS: COMFORT-B scores, originally and prospectively collected as part of standard care, were retrieved from the digital patient data management system...
April 2015: European Journal of Pain: EJP
Heidi A B Smith, Tyler Berutti, Emily Brink, Bradly Strohler, D Catherine Fuchs, E Wesley Ely, Pratik P Pandharipande
Critically ill children suffer from pain and anxiety additionally in the face of severe organ dysfunction. The critical care environment challenges pediatric patients' emotional and developmental capabilities. Disease-focused therapy is a priority and usually requires separation of patient from family and completion of invasive procedures. With the lack of familiar surroundings, inability to self-soothe, and deficiency of sleep, critically ill children may benefit from a multidisciplinary approach to care with a specific goal of pain management...
April 2013: Seminars in Respiratory and Critical Care Medicine
Peter N Johnson, Jamie L Miller, Tracy M Hagemann
The interplay of pain, discomfort, and fear can cause agitation in critically ill children. Therefore, sedation and analgesia are essential components in the intensive care unit setting and are best managed with a multidisciplinary team approach. No one standard approach exists to assess and manage pain and anxiety. Many tools are available for the assessment of pain and sedation, but each tool has its advantages and disadvantages. Clinicians should consider adopting a validated tool for routine continuous assessment...
October 2012: AACN Advanced Critical Care
Linda S Franck, Lisa A Scoppettuolo, David Wypij, Martha A Q Curley
Critically ill pediatric patients frequently receive prolonged analgesia and sedation to provide pain relief and facilitate intensive care therapies. Iatrogenic withdrawal syndrome occurs when these drugs are stopped abruptly or weaned too rapidly. We investigated the validity and generalizability of the Withdrawal Assessment Tool-1 (WAT-1) in children during weaning of analgesics and sedatives. Of 308 children initially supported on mechanical ventilation for acute respiratory failure, 126 (41%) from 21 centers (median age 1...
January 2012: Pain
P J Mathew, J L Mathew, S Singhi
BACKGROUND: Nurses' knowledge, sensitivity and attitudes about pain in children and its management affect their response and therefore management of pediatric pain. Children in critical care units undergo more painful procedures than those in general wards. AIMS: To study the knowledge, attitude and practice of nursing personnel catering to critically ill children in a developing country. SETTINGS AND DESIGN: Prospective questionnaire-based survey...
July 2011: Journal of Postgraduate Medicine
Cornelia Möllmann, Wolfgang Weinmann, Corinna Cavelius, Marcus Krüger
UNLABELLED: In this paper we describe the assessment and medical treatment of pain in children according to the concept of the Centre of Pediatrics and Adolescent Medicine at the university of Freiburg, Germany. Opiate therapy in children as well as novel data about the association of paracetamol (acetaminophen) and wheezing/asthma bronchiale in children are discussed. Special aspects of analgesia for painful procedures and a nitrous oxide/oxygen mixture which has been recently introduced in Germany are described...
January 2011: Medizinische Monatsschrift Für Pharmazeuten
Margot Thomas, Sonny Dhanani, Danica Irwin, Hilary Writer, Dermot Doherty
Sedation and analgesia are administered to critically ill children to provide comfort and pain relief, decrease anxiety and to promote patient safety in relation to life-saving treatments. A comprehensive practice guideline focused on ways to implement evidence-based sedation and analgesia practices was developed, disseminated and implemented by an interprofessional team in the pediatric intensive care unit (PICU) at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada. The goals of this quality of care initiative were to (1) reduce inconsistent practices, (2) improve patient outcomes related to comfort, and (3) enhance collaboration among health care team members caring for critically ill children...
2010: Dynamics: the Official Journal of the Canadian Association of Critical Care Nurses
F Benini, M Farina, A Capretta, A Messeri, P Cogo
AIM: To analyse the methods used to manage and monitor sedoanalgesia at Italian paediatric intensive care units (ICUs). METHODS: Data were collected by administering a questionnaire that aimed to investigate whether ICUs adopted a validated protocol to manage sedoanalgesia. RESULTS: The results revealed that a majority of the ICUs adopt a protocol for dealing with sedation and analgesia, but this protocol is implemented with difficulty or not at all in routine clinical practice...
May 2010: Acta Paediatrica
Erwin Ista, Matthijs de Hoog, Dick Tibboel, Monique van Dijk
OBJECTIVE: To study the effects of the introduction of a sedation treatment protocol for children in intensive care, including nurses' compliance. BACKGROUND: While several sedation guidelines for adults and children have been developed and implemented, there is little evidence on use of sedation protocols in critically ill infants. DESIGN: Pretest-posttest intervention study. METHODS: Administered sedatives and analgesics over the first seven days of admission were documented for convenience samples, before (n = 27) and after (n = 29) implementation of standard sedation assessments and a sedation protocol...
September 2009: Journal of Clinical Nursing
Debbie Long, Desley Horn, Samantha Keogh
INTRODUCTION: A retrospective analysis of sedation management for children receiving prolonged ventilation in one Australian paediatric intensive care unit (PICU) revealed no identifiable pattern in sedation management and an inadequacy in the sedation scoring system. Therefore, the investigators sought to explore the current practice of sedation in critically ill children in PICUs across Australia and New Zealand. METHOD: This study used a mail-out survey to audit sedation management within the eight dedicated Australian and New Zealand PICUs...
November 2005: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Lora A Bear, Peggy Ward-Smith
Pain assessment of the critically ill sedated patient is a challenge. Children who are critically ill may be unable to articulate pain, and they may have a decreased level of consciousness as a result of their disease state and/or analgesic and sedation medications. The COMFORT Scale (Ambuel, Hamlett, & Marx, 1990) can be used to assess psychological distress of critically ill children. This non-experimental comparison study evaluated the interrater (interobserver) reliability of the COMFORT Scale, using correlation techniques...
September 2006: Pediatric Nursing
C L S Cheung, M van Dijk, J W Green, D Tibboel, K J S Anand
OBJECTIVE: To develop novel therapies that prevent opioid tolerance in critically ill children we examined the effects of low-dose naloxone infusions on patients' needs for analgesia or sedation. DESIGN AND SETTING: Matched case-control study in a pediatric intensive care unit at a university children's hospital. PATIENTS: We compared 14 pediatric ICU patients receiving low-dose naloxone and opioid infusions with 12 matched controls receiving opioid infusions...
January 2007: Intensive Care Medicine
F Ferrero, E Lupo, L Caldara
Anxiolysis and pain control are a duty for physicians and must be treated very carefully in the Pediatric Intensive Care Units, although it is very difficult to assess them: in critically ill children sedatives and/or analgesic medications are routinely provided and titrated to obtain a satisfactory level of sedation, but different evaluation scores are needed to discriminate between light or inadequate and deep or excessive sedation, especially when the clinical examination is unavailable. It is usual to associate a benzodiazepin with an opioid, more often Midazolam and Morphine or Fentanyl; other drugs as Propofol, Clonidine and Ketamine have specific indications, brief painful procedures and weaning from long periods of sedation to avoid withdrawal...
May 2004: Minerva Anestesiologica
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