2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

DOI Web Site 被引用文献1件
  • Heidi A. B. Smith
    Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN.
  • James B. Besunder
    Division of Pediatric Critical Care, Akron Children’s Hospital, Akron, OH.
  • Kristina A. Betters
    Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN.
  • Peter N. Johnson
    University of Oklahoma College of Pharmacy, Oklahoma City, OK.
  • Vijay Srinivasan
    Departments of Anesthesiology, Critical Care, and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
  • Anne Stormorken
    Pediatric Critical Care, Rainbow Babies Children’s Hospital, Cleveland, OH.
  • Elizabeth Farrington
    Betty H. Cameron Women’s and Children’s Hospital at New Hanover Regional Medical Center, Wilmington, NC.
  • Brenda Golianu
    Division of Pediatric Anesthesia and Pain Management, Department of Anesthesiology, Lucile Packard Children’s Hospital, Palo Alto, CA.
  • Aaron J. Godshall
    Department of Pediatrics, AdventHealth For Children, Orlando, FL.
  • Larkin Acinelli
    Division of Critical Care Medicine, Johns Hopkins All Children’s Hospital, St Petersburg, FL.
  • Christina Almgren
    Lucile Packard Children’s Hospital Stanford Pain Management, Palo Alto, CA.
  • Christine H. Bailey
    Pediatric Critical Care, Moses Cone Hospital, Greensboro, NC.
  • Jenny M. Boyd
    Division of Pediatric Critical Care, N.C. Children’s Hospital, Chapel Hill, NC.
  • Michael J. Cisco
    Division of Pediatric Critical Care Medicine, UCSF Benioff Children’s Hospital San Francisco, San Francisco, CA.
  • Mihaela Damian
    Lucile Packard Children’s Hospital Stanford at Stanford Children’s Health, Palo Alto, CA.
  • Mary L. deAlmeida
    Children’s Healthcare of Atlanta at Egleston, Atlanta, GA.
  • James Fehr
    Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, CA.
  • Kimberly E. Fenton
    Department of Pediatrics, AdventHealth For Children, Orlando, FL.
  • Frances Gilliland
    Division of Cardiac Critical Care, Johns Hopkins All Children’s Hospital, St Petersburg, FL.
  • Mary Jo C. Grant
    Primary Children’s Hospital, Pediatric Critical Care Services, Salt Lake City, UT.
  • Joy Howell
    Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY.
  • Cassandra A. Ruggles
    Department of Pharmacy, Akron Children’s Hospital, Akron, OH.
  • Shari Simone
    University of Maryland School of Nursing, Baltimore, MD.
  • Felice Su
    Lucile Packard Children’s Hospital Stanford at Stanford Children’s Health, Palo Alto, CA.
  • Janice E. Sullivan
    “Just For Kids” Critical Care Center, Norton Children’s Hospital, Louisville, KY.
  • Ken Tegtmeyer
    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
  • Chani Traube
    Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY.
  • Stacey Williams
    Division of Pediatric Critical Care, Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, TN.
  • John W. Berkenbosch
    “Just For Kids” Critical Care Center, Norton Children’s Hospital, Louisville, KY.

抄録

<jats:sec><jats:title>RATIONALE:</jats:title><jats:p>A guideline that both evaluates current practice and provides recommendations to address sedation, pain, and delirium management with regard for neuromuscular blockade and withdrawal is not currently available.</jats:p></jats:sec><jats:sec><jats:title>OBJECTIVE:</jats:title><jats:p>To develop comprehensive clinical practice guidelines for critically ill infants and children, with specific attention to seven domains of care including pain, sedation/agitation, iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment, and early mobility.</jats:p></jats:sec><jats:sec><jats:title>DESIGN:</jats:title><jats:p>The Society of Critical Care Medicine Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility Guideline Taskforce was comprised of 29 national experts who collaborated from 2009 to 2021 via teleconference and/or e-mail at least monthly for planning, literature review, and guideline development, revision, and approval. The full taskforce gathered annually in-person during the Society of Critical Care Medicine Congress for progress reports and further strategizing with the final face-to-face meeting occurring in February 2020. Throughout this process, the Society of Critical Care Medicine standard operating procedures Manual for Guidelines development was adhered to.</jats:p></jats:sec><jats:sec><jats:title>METHODS:</jats:title><jats:p>Taskforce content experts separated into subgroups addressing pain/analgesia, sedation, tolerance/iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment (family presence and sleep hygiene), and early mobility. Subgroups created descriptive and actionable Population, Intervention, Comparison, and Outcome questions. An experienced medical information specialist developed search strategies to identify relevant literature between January 1990 and January 2020. Subgroups reviewed literature, determined quality of evidence, and formulated recommendations classified as “strong” with “we recommend” or “conditional” with “we suggest.” Good practice statements were used when indirect evidence supported benefit with no or minimal risk. Evidence gaps were noted. Initial recommendations were reviewed by each subgroup and revised as deemed necessary prior to being disseminated for voting by the full taskforce. Individuals who had an overt or potential conflict of interest abstained from relevant votes. Expert opinion alone was not used in substitution for a lack of evidence.</jats:p></jats:sec><jats:sec><jats:title>RESULTS:</jats:title><jats:p>The Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility taskforce issued 44 recommendations (14 strong and 30 conditional) and five good practice statements.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS:</jats:title><jats:p>The current guidelines represent a comprehensive list of practical clinical recommendations for the assessment, prevention, and management of key aspects for the comprehensive critical care of infants and children. Main areas of focus included 1) need for the routine monitoring of pain, agitation, withdrawal, and delirium using validated tools, 2) enhanced use of protocolized sedation and analgesia, and 3) recognition of the importance of nonpharmacologic interventions for enhancing patient comfort and comprehensive care provision.</jats:p></jats:sec>

収録刊行物

被引用文献 (1)*注記

もっと見る

詳細情報 詳細情報について

問題の指摘

ページトップへ