title: Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals.
abstract: 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.
authors.affiliation: PICU Department of Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Harris
authors.affiliation: Institute of Higher Education and Nursing Research, University of Lausanne, CHUV, Lausanne, Switzerland.
authors.forename: Anne-Sylvie
authors.initials: AS
authors.lastname: Ramelet
authors.affiliation: Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Office Sb-2704, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.|Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: van Dijk
authors.affiliation: Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Office Sb-2704, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.|Intensive Care Unit, Department of Pediatrics, General Faculty Hospital, First Faculty of Medicine Charles University in Prague, Prague, Czech Republic.|Department of Pharmacology, General University Hospital, 1st Faculty of Medicine Charles University, Prague, Czech Republic.
authors.forename: Pavla
authors.initials: P
authors.lastname: Pokorna
authors.affiliation: Department of Intensive Care Neonatology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Joke
authors.initials: J
authors.lastname: Wielenga
authors.affiliation: PICU and Children's Nursing Research Unit, Alder Hey Children's NHS FT, Liverpool UK and University of Central Lancashire, Preston, UK.
authors.forename: Lyvonne
authors.initials: L
authors.lastname: Tume
authors.affiliation: Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Office Sb-2704, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.affiliation: Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Office Sb-2704, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. w.ista@erasmusmc.nl.
authors.forename: Erwin
authors.initials: E
authors.lastname: Ista
mesh_terms: D002648:Child; D002675:Child, Preschool; D032921:Consensus; D016638:Critical Illness; D003693:Delirium / Q000175:diagnosis / Q000628:therapy*; D000071257:Emergence Delirium / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000592:standards*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods*; D017410:Practice Guidelines as Topic; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000188:drug therapy; D013315:Stress, Psychological; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000628:therapy*
chemical_list: D006993:Hypnotics and Sedatives
keywords: Assessment; Delirium; Distress; Pain; Sedation; Withdrawal syndrome