Pain and Sedation Management in Mechanically Ventilated Children

Lauren Sorce; Shari Simone

doi:10.1055/s-0035-1556748

Journal of Pediatric Intensive Care, Inhaltsverzeichnis

J Pediatr Intensive Care 2015; 04(02): 064-072
DOI: 10.1055/s-0035-1556748

Review Article

Georg Thieme Verlag KG Stuttgart · New York

Pain and Sedation Management in Mechanically Ventilated Children

Lauren Sorce

¹Department of Nursing, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States

,

Shari Simone

²Women and Children's Service, University of Maryland Medical Center, University of Maryland School of Nursing Pediatric Acute Care, Baltimore, Maryland, United States

› Institutsangaben

Abstract

Assessing and managing pain and agitation in critically ill children can be challenging. Multiple factors contribute to the challenges of management, including prior medication exposure, surgical and procedural interventions, pharmacokinetics, and age-related pharmacodynamics making the population heterogeneous. Therefore, individualizing treatment approaches embedded with frequent assessments is likely to improve the management of pain and agitation in critically ill children. Novel approaches to manage pain and agitation continue to evolve and will require ongoing evaluation prior to widespread adoption.

Keywords

pain - agitation - sedation - analgesia - assessment - pediatric - pediatric critical care

Volltext

Referenzen

References
1 Dorfman TL, Sumamo Schellenberg E, Rempel GR, Scott SD, Hartling L. An evaluation of instruments for scoring physiological and behavioral cues of pain, non-pain related distress, and adequacy of analgesia and sedation in pediatric mechanically ventilated patients: A systematic review. Int J Nurs Stud 2014; 51 (4) 654-676
2 Schweickert WD, Kress JP. Strategies to optimize analgesia and sedation. Crit Care 2008; 12 (Suppl. 03) S6
3 Poh YN, Poh PF, Buang SN, Lee JH. Sedation guidelines, protocols, and algorithms in PICUs: a systematic review. Pediatr Crit Care Med 2014; 15 (9) 885-892
4 Hartman ME, McCrory DC, Schulman SR. Efficacy of sedation regimens to facilitate mechanical ventilation in the pediatric intensive care unit: a systematic review. Pediatr Crit Care Med 2009; 10 (2) 246-255
5 Barr J, Fraser GL, Puntillo K , et al; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41 (1) 263-306
6 Deeter KH, King MA, Ridling D, Irby GL, Lynn AM, Zimmerman JJ. Successful implementation of a pediatric sedation protocol for mechanically ventilated patients. Crit Care Med 2011; 39 (4) 683-688
7 Curley MAQ, Wypii D, Watson S , et al. Protocolized sedation vs usual care in pediatric patients mechanically ventilated for acute respiratory failure: a randomized clinical trial. JAMA 2015; 313 (4) 379-389
8 Hoy SM, Keating GM. Dexmedetomidine: a review of its use for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation. Drugs 2011; 71 (11) 1481-1501
9 Fagin A, Palmieri T, Greenhalgh D, Sen S. A comparison of dexmedetomidine and midazolam for sedation in severe pediatric burn injury. J Burn Care Res 2012; 33 (6) 759-763
10 Gupta K, Gupta VK, Jayashree M, Singhi S. Randomized controlled trial of interrupted versus continuous sedative infusions in ventilated children. Pediatr Crit Care Med 2012; 13 (2) 131-135
11 Burbano NH, Otero AV, Berry DE, Orr RA, Munoz RA. Discontinuation of prolonged infusions of dexmedetomidine in critically ill children with heart disease. Intensive Care Med 2012; 38 (2) 300-307
12 Lam F, Ransom C, Gossett JM , et al. Safety and efficacy of dexmedetomidine in children with heart failure. Pediatr Cardiol 2013; 34 (4) 835-841
13 Le KN, Moffett BS, Ocampo EC, Zaki J, Mossad EB. Impact of dexmedetomidine on early extubation in pediatric cardiac surgical patients. Intensive Care Med 2011; 37 (4) 686-690
14 Lin H, Faraklas I, Sampson C, Saffle JR, Cochran A. Use of dexmedetomidine for sedation in critically ill mechanically ventilated pediatric burn patients. J Burn Care Res 2011; 32 (1) 98-103
15 Hosokawa K, Shime N, Kato Y , et al. Dexmedetomidine sedation in children after cardiac surgery. Pediatr Crit Care Med 2010; 11 (1) 39-43
16 Czaja AS, Zimmerman JJ. The use of dexmedetomidine in critically ill children. Pediatr Crit Care Med 2009; 10 (3) 381-386
17 Buck ML, Willson DF. Use of dexmedetomidine in the pediatric intensive care unit. Pharmacotherapy 2008; 28 (1) 51-57
18 Chrysostomou C, Di Filippo S, Manrique AM , et al. Use of dexmedetomidine in children after cardiac and thoracic surgery. Pediatr Crit Care Med 2006; 7 (2) 126-131
19 Whalen LD, Di Gennaro JL, Irby GA, Yanay O, Zimmerman JJ. Long-term dexmedetomidine use and safety profile among critically ill children and neonates. Pediatr Crit Care Med 2014; 15 (8) 706-714
20 Walker J, Maccallum M, Fischer C, Kopcha R, Saylors R, McCall J. Sedation using dexmedetomidine in pediatric burn patients. J Burn Care Res 2006; 27 (2) 206-210
21 Phan H, Nahata MC. Clinical uses of dexmedetomidine in pediatric patients. Paediatr Drugs 2008; 10 (1) 49-69
22 Carney L, Kendrick J, Carr R. Safety and effectiveness of dexmedetomidine in the pediatric intensive care unit (SAD-PICU). Can J Hosp Pharm 2013; 66 (1) 21-27
23 Dahmani S, Brasher C, Stany I , et al. Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies. Acta Anaesthesiol Scand 2010; 54 (4) 397-402
24 Lambert P, Cyna AM, Knight N, Middleton P. Clonidine premedication for postoperative analgesia in children. Cochrane Database Syst Rev 2014; 1: CD009633
25 Hirota T, Schwartz S, Correll CU. Alpha-2 agonists for attention-deficit/hyperactivity disorder in youth: a systematic review and meta-analysis of monotherapy and add-on trials to stimulant therapy. J Am Acad Child Adolesc Psychiatry 2014; 53 (2) 153-173
26 Duffett M, Choong K, Foster J , et al. Clonidine in the sedation of mechanically ventilated children: a pilot randomized trial. J Crit Care 2014; 29 (5) 758-763
27 Hünseler C, Balling G, Röhlig C , et al; Clonidine Study Group. Continuous infusion of clonidine in ventilated newborns and infants: a randomized controlled trial. Pediatr Crit Care Med 2014; 15 (6) 511-522
28 Long D, Erickson S ; for the ANZICS Paediatric Study Group. Baby spice: sedation practice in paediatric intensive care evaluation in Australia and New Zealand. Pediatr Crit Care Med 2014; 15 (4, Suppl): 19 (Abstract)
29 Arenas-López S, Riphagen S, Tibby SM , et al. Use of oral clonidine for sedation in ventilated paediatric intensive care patients. Intensive Care Med 2004; 30 (8) 1625-1629
30 Vet NJ, de Wildt SN, Verlaat CW , et al; SKIC (Dutch collaborative PICU research network). Daily interruption of sedation in critically ill children: study protocol for a randomized controlled trial. Trials 2014; 15: 55