Analgesia, Deep Sedation
Conditions
Keywords
Analgesia, intensive care units, clinical protocol, deep sedation, nursing assessment
Brief summary
Management of analgesia and sedation is an integral component of the medical care of a critically-ill child. Its role is to assure comfort and safety to a patient undergoing painful cares and technical procedures; it can also be, in particular situations like acute respiratory distress syndrome or acute brain injury, a full processing treatment. Sedation involves, most of the time, the association of an opioid and a sedative. The use of these drugs is difficult in children, because of a specific metabolism, inducing tolerance and withdrawal in case of prolonged administration. The COMFORT-BEHAVIOR (COMFORT-B) scale is a validated, simple, reliable and reproducible score evaluating sedation and analgesia. Sedation scoring systems must be used regularly to avoid inadequate sedation. Excessive sedation is associated with poor outcomes like prolonged mechanical ventilation, longer hospitalisation and more frequent withdrawal symptoms. Adult and paediatric data suggest that goal-directed sedation algorithms allow a more appropriate adaptation of the treatment to the patient's need and permit a reduction in the duration of mechanical ventilation. The objective was to evaluate the impact of a nurse-driven sedation protocol in a paediatric intensive care unit on duration of mechanical ventilation, total doses and duration of medications, Paediatric Intensive Care Unit (PICU) length of stay, incidence of ventilator-associated-pneumonia and occurrence of withdrawal.
Interventions
BEHAVIORALNurse-driven sedation protocol
The nurse-driven sedation protocol included the COMFORT-B scale. Initial doses were chosen by the physicians then all changes were made by the nurses with the aim of attaining an optimal range of analgesia and sedation, which was defined as values from 11 to 17 on the COMFORT-B score.
Sponsors
Hospices Civils de Lyon
Study design
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
No minimum to 18 Years
Healthy volunteers
No
Inclusion criteria
* Mechanically-ventilated patients aged from 0 to 18 years receiving sedation for more than 24 hours
Exclusion criteria
* Patients with tracheostomy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Duration of mechanical ventilation (days) | Over the PICU stay of each child (Day 5) |
Secondary
| Measure | Time frame |
|---|---|
| Total doses of sedatives (unit/kg) | Over the PICU stay of each child (Day 5) |
| Occurrence of withdrawal symptoms | Over the PICU stay of each child (Day 5) |
| Length of PICU stay (days) | Over the PICU stay of each child (Day 5) |
Countries
France
Outcome results
None listed