Guidelines for sedation of the critically ill child.

Abstract

Michelle Bennett RGN, RSCN, ENB 998, ENB N51, BSc(Hons), Lecturer Practitioner, Paediatric Intensive Care, Queen’s Medical Centre, Nottingham Critically ill children often receive sedative agents and analgesics to induce sedation in order to reduce their body’s stress responses, relieve pain and anxiety, prevent dislodgement of essential invasive lines and facilitate supportive measures (Fonsmark et al 1999, Scottish Intercollegiate Guidelines Network (SIGN) 2002). These medications are essential for the safe management of a critically ill child but unfortunately they can have several undesirable side effects, including physical dependence, tolerance and withdrawal symptoms. As Carnevale and Ducharme (1997) write, the time course and pharmacology of sedatives in children differ greatly from that of adults, and recognition of iatrogenic withdrawal reactions in the paediatric critical care setting is only now beginning to emerge. As a result of concerns raised in the paediatric intensive care unit (PICU), Queen’s Medical Centre, Nottingham, the author has devised sedation guidelines based on current research findings and incorporating a combined sedation and comfort assessment score, a weaning programme and a withdrawal symptoms assessment score (see Box 1). This article reviews the research findings regarding sedation assessment and management in the PICU setting and highlights the changes to practice made by the implementation of the guidelines.