Guidelines address seven domains of care, including analgesia, sedation, delirium, and optimizing the environment
MONDAY, Feb. 14, 2022 (HealthDay News) — In 2022 clinical practice guidelines issued by the Society of Critical Care Medicine and published in the February issue of Pediatric Critical Care Medicine, recommendations are presented for the management of critically ill pediatric patients.
Heidi A.B. Smith, M.D., from the Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues developed clinical practice guidelines for critically ill infants and children, focusing on seven domains of care.
The task force issued 44 recommendations (14 strong and 30 conditional) and five good practice statements. In terms of analgesia, use of either the Faces, Legs, Activity, Cry, and Consolability or COMFORT-B scales is recommended for assessing pain in noncommunicative critically ill pediatric patients. Observational pain assessment tools are recommended rather than vital signs alone for assessment of postoperative pain. Intravenous opioids are recommended as the primary analgesic for treating moderate-to-severe pain in critically ill pediatric patients. For sedation, the COMFORT-B Scale or State Behavioral Scale is recommended to assess the level of sedation for mechanically ventilated pediatric patients. Dexmedetomidine should be considered as a primary agent for sedation in postoperative cardiac surgical patients with expected early extubation. Routine screening for intensive care unit (ICU) delirium is recommended using a validated tool for critically ill pediatric patients. To reduce incidence and/or duration or severity of delirium, benzodiazepine-based sedation should be minimized when feasible. Facilitation of parental or caregiver presence in the pediatric ICU during routine care and interventional procedures is suggested.
“We intend that these guidelines stress the use of validated tools for making these assessments within each domain, and advocate for their development if validated tools are not yet available,” the authors write.
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