title: Practice guidelines for sedation and analgesia management of critically ill children: a pilot study evaluating guideline impact and feasibility in the PICU.
abstract: OBJECTIVE
  The aim of this study was to develop and implement guidelines for sedation and analgesia management in the paediatric intensive care unit (PICU) and evaluate the impact, feasibility and acceptability of these as part of a programme of research in this area and as a prelude to future trial work.
  
  
  METHODS
  This pilot study used a pre-post design using a historical control.
  
  
  METHODS
  Two PICUs at different hospitals in an Australian metropolitan city.
  
  
  METHODS
  Patients admitted to the PICU and ventilated for ≥24 h, aged more than 1 month and not admitted for seizure management or terminal care.
  
  
  METHODS
  Guidelines for sedation and analgesia management for critically ill children including algorithm and assessment tools.
  
  
  METHODS
  In addition to key outcome variables (ventilation time, medication dose and duration, length of stay), feasibility outcomes data (recruitment, data collection, safety) were evaluated. Guideline adherence was assessed through chart audit and staff were surveyed about merit and the use of guidelines.
  
  
  RESULTS
  The guidelines were trialled for a total of 12 months on 63 patients and variables compared with the historical control group (n=75). Analysis revealed differences in median Morphine infusion duration between groups (pretest 3.63 days (87 h) vs post-test 2.83 days (68 h), p=0.05) and maximum doses (pretest 120 μg/kg/h vs post-test 97.5 μg/kg/h) with no apparent change to ventilation duration. Chart audit revealed varied use of tools, but staff were positive about the guidelines and their use in practice.
  
  
  CONCLUSIONS
  The sedation guidelines impacted on the duration and dosage of agents without any apparent impact on ventilation duration or length of stay. Furthermore, the guidelines appeared to be feasible and acceptable in clinical practice. The results of the study have laid the foundation for follow-up studies in withdrawal from sedation, point prevalence and longitudinal studies of sedation practices as well as drug trial work.
authors.affiliation: Nursing Research Services, Royal Children's Hospital, Brisbane, Queensland, Australia NHMRC Centre of Research Excellence in Nursing (NCREN)-Centre for Health Practice Innovation-Griffith Health Institute, Griffith University, Nathan, Australia.
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Keogh
authors.affiliation: Paediatric Intensive Care Unit, Royal Children's Hospital, Brisbane, Queensland, Australia NHMRC Centre of Research Excellence in Nursing (NCREN)-Centre for Health Practice Innovation-Griffith Health Institute, Griffith University, Nathan, Australia.
authors.forename: Debbie A
authors.initials: DA
authors.lastname: Long
authors.affiliation: Paediatric Intensive Care Unit, Royal Children's Hospital, Brisbane, Queensland, Australia.
authors.forename: Desley V
authors.initials: DV
authors.lastname: Horn
mesh_terms: D000698:Analgesia / Q000379:methods*; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D019983:Guideline Adherence; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D015278:Intensive Care Units, Pediatric; D010865:Pilot Projects; D017410:Practice Guidelines as Topic
chemical_list: D006993:Hypnotics and Sedatives
references.citation: Intensive Care Med. 2006 Aug;32(8):1125-36
references.pmid: 16699772
references.citation: Curr Opin Anaesthesiol. 2009 Jun;22(3):368-73
references.pmid: 19434780
references.citation: Intensive Crit Care Nurs. 2005 Jun;21(3):179-86
references.pmid: 15907670
references.citation: Intensive Care Med. 2003 Feb;29(2):278-85
references.pmid: 12541154
references.citation: J Clin Psychiatry. 1982 Jun;43(6 Pt 2):30-4
references.pmid: 7045089
references.citation: Cochrane Database Syst Rev. 2006 Apr 19;(2):CD001814
references.pmid: 16625548
references.citation: Aust Crit Care. 2004 Nov;17(4):151-9
references.pmid: 18038524
references.citation: Crit Care Med. 2000 Jun;28(6):2122-32
references.pmid: 10890677
references.citation: Crit Care Med. 2011 Apr;39(4):683-8
references.pmid: 21263324
references.citation: Cochrane Database Syst Rev. 2015 Jan 07;1:CD009771
references.pmid: 25562750
references.citation: Aust Crit Care. 1999 Sep;12(3):92-6
references.pmid: 10795180
references.citation: J Postgrad Med. 1999 Jul-Sep;45(3):95-102
references.pmid: 10734346
references.citation: Clin Nurse Spec. 2012 Jan-Feb;26(1):22-8
references.pmid: 22146270
references.citation: Intensive Care Med. 2013 Sep;39(9):1524-34
references.pmid: 23778830
references.citation: BMJ. 2002 Jun 8;324(7350):1386-9
references.pmid: 12052813
references.citation: Crit Care Med. 1998 Apr;26(4):676-84
references.pmid: 9559604
references.citation: Paediatr Anaesth. 2007 Dec;17(12):1156-65
references.pmid: 17986034
references.citation: Aust Crit Care. 2013 Aug;26(3):118-23
references.pmid: 23680532
references.citation: Cochrane Database Syst Rev. 2004;(2):CD000390
references.pmid: 15106151
references.citation: Paediatr Drugs. 1999 Apr-Jun;1(2):109-26
references.pmid: 10937446
references.citation: Pediatr Crit Care Med. 2006 Mar;7(2):107-14
references.pmid: 16446601
references.citation: Paediatr Anaesth. 2007 Jul;17(7):675-83
references.pmid: 17564650
references.citation: Crit Care Med. 2000 Jul;28(7):2300-6
references.pmid: 10921556
references.citation: Intensive Crit Care Nurs. 2002 Oct;18(5):292-301
references.pmid: 12487435
references.citation: Pediatrics. 2007 Oct;120(4):842-54
references.pmid: 17908772
references.citation: J Clin Nurs. 2009 Sep;18(17):2511-20
references.pmid: 19619202
references.citation: Pediatr Crit Care Med. 2004 Nov;5(6):521-32
references.pmid: 15530187
references.citation: J Korean Med Sci. 2007 Aug;22(4):693-7
references.pmid: 17728512
references.citation: Intensive Crit Care Nurs. 2004 Dec;20(6):344-51
references.pmid: 15567675
references.citation: Intensive Care Med. 1994 Aug;20(7):504-7
references.pmid: 7995868
references.citation: Paediatr Anaesth. 2007 Apr;17(4):333-40
references.pmid: 17359401
references.citation: Clin Pharmacokinet. 1998 Jul;35(1):37-47
references.pmid: 9673833
references.citation: Crit Care Clin. 2000 Oct;16(4):723-34, xi
references.pmid: 11070814
references.citation: Intensive Care Med. 2007 Aug;33(8):1396-406
references.pmid: 17541548
references.citation: Crit Care Clin. 2009 Jul;25(3):471-88, vii-viii
references.pmid: 19576525
references.citation: Aust Crit Care. 2005 Nov;18(4):152-7
references.pmid: 18038536
references.citation: Implement Sci. 2006 Apr 28;1:9
references.pmid: 16722539
references.citation: Pediatr Crit Care Med. 2010 Mar;11(2):217-26
references.pmid: 19770789
references.citation: Cochrane Database Syst Rev. 2011 Oct 05;(10):CD006275
references.pmid: 21975752
references.citation: Crit Care Med. 1999 Dec;27(12):2609-15
references.pmid: 10628598
references.citation: Int J Qual Health Care. 1999 Jun;11(3):187-92
references.pmid: 10435838
references.citation: Am J Respir Crit Care Med. 2012 Oct 15;186(8):724-31
references.pmid: 22859526
references.citation: Pediatr Crit Care Med. 2002 Apr;3(2):129-133
references.pmid: 12780981
references.citation: J Nurs Res. 2004 Mar;12(1):31-40
references.pmid: 15136961
references.citation: Paediatr Nurs. 2003 Nov;15(9):14-8
references.pmid: 14669695
references.citation: Paediatr Anaesth. 2003 Feb;13(2):147-51
references.pmid: 12562488
references.citation: Crit Care Nurs Clin North Am. 1997 Sep;9(3):251-72
references.pmid: 9355351
references.citation: Paediatr Anaesth. 2004 Apr;14(4):293-8
references.pmid: 15078373
references.citation: Crit Care Med. 2002 Jan;30(1):119-41
references.pmid: 11902253
references.citation: Am Surg. 2000 Apr;66(4):367-70; discussion 370-1
references.pmid: 10776874
references.citation: Crit Care Med. 1999 Jan;27(1):196-9
references.pmid: 9934916
references.citation: Am J Crit Care. 1998 Sep;7(5):364-9
references.pmid: 9740886
references.citation: Neonatal Netw. 1995 Mar;14(2):39-48
references.pmid: 7746239
references.citation: Ann Pharmacother. 1997 Jun;31(6):689-95
references.pmid: 9184706