Consensus guidelines on sedation and analgesia in critically ill children.
OBJECTIVE
The United Kingdom Paediatric Intensive Care Society Sedation, Analgesia and Neuromuscular Blockade Working Group is a multi-disciplinary expert panel created to produce consensus guidelines on sedation and analgesia in critically ill children and forward knowledge in these areas. Sedation and analgesia are recognised as important areas of critical care practice and adult clinical practice guidelines in these fields remain amongst the most popular of those produced by the Society of Critical Care Medicine. However, similar clinical practice guidelines have not previously been produced for the critically ill paediatric patient.


METHODS
A modified Delphi technique was used to allow the Working Group to anonymously consider draft recommendations in three Delphi rounds with predetermined levels of agreement. This process was supported by a total of four consensus conferences. Once consensus had been reached, a systematic review of the available literature was carried out.


RESULTS
A set of consensus guidelines was produced including 20 key recommendations, 10 relating to the provision of analgesia and 10 relating to the sedation of critically ill children. An evaluation of the existing literature supporting these recommendations is provided.


CONCLUSIONS
Multi-disciplinary consensus guidelines for maintenance sedation and analgesia in critically ill children have been successfully produced and are supported by levels of evidence (excluding sedation and analgesia for procedures and excluding neonates). The working group has highlighted the paucity of high-quality evidence in these important clinical areas and this emphasises the need for further randomised clinical trials in this area.
Playfor
Stephen
S
Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Hospital Road, M27 4HA, Manchester, UK. stephen.playfor@cmmc.nhs.uk
Jenkins
Ian
I
Boyles
Carolyne
C
Choonara
Imti
I
Davies
Gerald
G
Haywood
Tim
T
Hinson
Gillian
G
Mayer
Anton
A
Morton
Neil
N
Ralph
Tanya
T
Wolf
Andrew
A
D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use*; D002648:Child; D016292:Procedural Sedation / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*
D000700:Analgesics; D006993:Hypnotics and Sedatives