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Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals

Harris, Julia; Ramelet, Anne Sylvie; van Dijk, Monique; Pokorna, Pavla; Wielenga, Joke; Tume, Lyvonne; Tibboel, Dick; Ista, Erwin

Authors

Julia Harris

Anne Sylvie Ramelet

Monique van Dijk

Pavla Pokorna

Joke Wielenga

Lyvonne Tume Lyvonne.Tume@uwe.ac.uk
Associate Professor in Child Health

Dick Tibboel

Erwin Ista



Abstract

© 2016, The Author(s). 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. Methods: A multidisciplinary group of experts was recruited from the members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). The group formulated clinical questions regarding assessment of pain and non-pain-related distress in critically ill and nonverbal children, and searched the PubMed/Medline, CINAHL and Embase databases for studies describing the psychometric properties of assessment instruments. Furthermore, level of evidence of selected studies was assigned and recommendations were formulated, and grade or recommendations were added on the basis of the level of evidence. Results: An ESPNIC position statement was drafted which provides clinical recommendations on assessment of pain (n=5), distress and/or level of sedation (n=4), iatrogenic withdrawal syndrome (n=3) and delirium (n=3). These recommendations were based on the available evidence and consensus amongst the experts and other members of ESPNIC. Conclusions: This multidisciplinary ESPNIC position statement guides professionals in the assessment and reassessment of the effectiveness of treatment interventions for pain, distress, inadequate sedation, withdrawal syndrome and delirium.

Journal Article Type Review
Publication Date Jun 1, 2016
Journal Intensive Care Medicine
Print ISSN 0342-4642
Electronic ISSN 1432-1238
Publisher Springer (part of Springer Nature)
Peer Reviewed Peer Reviewed
Volume 42
Issue 6
Pages 972-986
APA6 Citation Harris, J., Ramelet, A. S., van Dijk, M., Pokorna, P., Wielenga, J., Tume, L., …Ista, E. (2016). Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals. Intensive Care Medicine, 42(6), 972-986. https://doi.org/10.1007/s00134-016-4344-1
DOI https://doi.org/10.1007/s00134-016-4344-1
Keywords Critical Care and Intensive Care Medicine
Publisher URL https://doi.org/10.1007/s00134-016-4344-1

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