Tolerance, withdrawal, and physical dependency after long-term sedation and analgesia of children in the pediatric intensive care unit

2000 ◽  
Vol 28 (6) ◽  
pp. 2122-2132 ◽  
Author(s):  
Joseph D. Tobias
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Sedation And Analgesia

The Impact of Implementing a “Pain, Agitation, and Delirium Bundle” in a Pediatric Intensive Care Unit: Improved Delirium Diagnosis

2021 ◽  
Author(s):  
Lise D. Cloedt ◽  
Kenza Benbouzid ◽  
Annie Lavoie ◽  
Marie-Élaine Metras ◽  
Marie-Christine Lavoie ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Post Intervention ◽  
Number Of Patients ◽  
Implementation Period ◽  
Short And Long Term ◽  
The Impact

AbstractDelirium is associated with significant negative outcomes, yet it remains underdiagnosed in children. We describe the impact of implementing a pain, agitation, and delirium (PAD) bundle on the rate of delirium detection in a pediatric intensive care unit (PICU). This represents a single-center, pre-/post-intervention retrospective and prospective cohort study. The study was conducted at a PICU in a quaternary university-affiliated pediatric hospital. All patients consecutively admitted to the PICU in October and November 2017 and 2018. Purpose of the study was describe the impact of the implementation of a PAD bundle. The rate of delirium detection and the utilization of sedative and analgesics in the pre- and post-implementation phases were measured. A total of 176 and 138 patients were admitted during the pre- and post-implementation phases, respectively. Of them, 7 (4%) and 44 (31.9%) were diagnosed with delirium (p < 0.001). Delirium was diagnosed in the first 48 hours of PICU admission and lasted for a median of 2 days (interquartile range [IQR]: 2–4). Delirium diagnosis was higher in patients receiving invasive ventilation (p < 0.001). Compliance with the PAD bundle scoring was 79% for the delirium scale. Score results were discussed during medical rounds for 68% of the patients in the post-implementation period. The number of patients who received opioids and benzodiazepines and the cumulative doses were not statistically different between the two cohorts. More patients received dexmedetomidine and the cumulative daily dose was higher in the post-implementation period (p < 0.001). The implementation of a PAD bundle in a PICU was associated with an increased recognition of delirium diagnosis. Further studies are needed to evaluate the impact of this increased diagnostic rate on short- and long-term outcomes.

The Role of Long-Term Electroencephalogram Monitoring in the Prognostic Evaluation of Children with Disturbance of Consciousness in Pediatric Intensive Care Unit

2021 ◽  
Vol 7 (5) ◽  
pp. 1214-1221
Author(s):  
Xiaobo Wu ◽  
Ruiqin Qiu ◽  
Baoqi Li ◽  
Heyuan Gao ◽  
Ying Su
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Medical Records ◽  
Compliance Rate ◽  
Pediatric Intensive Care ◽  
Prognostic Evaluation ◽  
Disturbance Of Consciousness

This study aimed to investigate the role of long-term video electroencephalogram (VEEG) monitoring in the diagnosis and prognostic evaluation of children with disturbance of consciousness in pediatric intensive care unit (PICU). Materials and Methods : A retrospective analysis was performed on the medical records of 107 children with severe brain injury (SBI) who admitted to the PICU of The First Hospital of Qinhuangdao from January 2014 to December 2015. The medical records of 100 children with mild disturbance of consciousness were analyzed. All children underwent routine electroencephalogram (REEG) and VEEG detections. The diagnosis was completed by physicians according to the relevant operation instructions. The brain waveform of children was monitored. Result : The diagnostic results of REEG and VEEG were compared with clinical diagnostic results, and the relationship between the two detections and the prognosis of SBI children was analyzed. The sensitivity of VEEG in the diagnosis of SBI children was significantly higher than that of REEG (P<0.050). The specificity of VEEG in the diagnosis of SBI children was higher than that of REEG, with a statistical significance (P<0.050). The diagnostic compliance rate of VEEG in the diagnosis of SBI children was significantly higher than that of REEG (P<0.050). The sensitivity of VEEG in evaluating the prognosis of SBI children was significantly higher than that of REEG (P<0.050). The specificity of VEEG in evaluating the prognosis of SBI children was significantly higher than that of REEG. The coincidence rate of VEEG in evaluating the prognosis of SBI children was significantly higher than that of REEG (P<0.050). Conclusion: The results indicated that VEEG detection is effective in the diagnosis and prognostic evaluation of SBI children with disturbance of consciousness, which is worthy of promotion in clinical practice.

scholarly journals A Peer and Volunteer Program for Patients and Their Families in the Pediatric Intensive Care Unit: A Pilot Program Evaluation

2021 ◽  
Vol 9 ◽  
Author(s):  
Nichole Pereira ◽  
Christine MacDonald ◽  
Ashley Drobot ◽  
Alexandra Bennett ◽  
Al-Bakir Ali ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Program Evaluation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Successful Implementation ◽  
Developmental Care ◽  
Volunteer Program ◽  
Stakeholder Groups

Introduction: Patients in the pediatric intensive care unit (PICU) are at risk of developing long-term morbidities following recovery from their critical illness. One such health outcome is called post-intensive care syndrome (PICS). PICS in pediatrics may be mitigated by interventions that facilitate adjustment to the PICU setting.Methods: The PICU implemented a two-pronged Peer and Volunteer (P/V) Program to help: (a) families adjust to the PICU experience with the support of a peer mentor (PM); and (b) patients receive non-medical interaction from trained volunteers (V). We designed a mixed-methods program evaluation targeting perspectives and feedback from PICU families and healthcare professionals (HCPs).Results: All stakeholder groups agreed that the PICU P/V Program was a valuable resource for PICU patients and their families. HCPs reported that they lack both time and training to provide regular developmental care to patients. However, the P/V Program may influence both families' and HCP's confidence in their ability to offer non-medical interaction to children in the PICU.Discussion: Important initial and on-going strengths and barriers to successful implementation were identified, including the need to clarify roles and intervention scope. The program evaluation served as a change management strategy and also helped to identify both areas for improvement and strategies for on-going sustainability. HCP's exposure to the program and modeling by PMs may have helped HCPs to feel that it is within their job description and capacity to provide emotional support and guidance to families.

Out-patient Therapy of Iatrogenic Opioid Dependency following Prolonged Sedation in the Pediatric Intensive Care Unit

1996 ◽  
Vol 11 (5) ◽  
pp. 284-287 ◽  
Author(s):  
Joseph D. Tobias
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Opioid Withdrawal ◽  
Opioid Dependency ◽  
Oral Methadone ◽  
Prolonged Sedation ◽  
Sedation And Analgesia ◽  
Patient Use

As a result of heightened awareness of the need for aggressive sedation and analgesia in the pediatric intensive care unit population, the risk for opioid withdrawal continues to increase. Although gradual tapering of the intravenous dose of opioid can be used to prevent such problems, this approach mandates maintenance of intravenous access and in-patient hospital admission. I present experience with the out-patient use of oral methadone to prevent opioid withdrawal following prolonged fentanyl sedation in the pediatric intensive care unit. A cohort of 18 patients is reviewed, and suggested guidelines for out-patient management of these patients using oral methadone are presented.

Sedation and Analgesia for Children in the Pediatric Intensive Care Unit

1995 ◽  
Vol 10 (6) ◽  
pp. 294-314 ◽  
Author(s):  
Joseph D. Tobias
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Anesthetic Techniques ◽  
Anesthetic Agents ◽  
Inhalational Anesthetic ◽  
Sedation And Analgesia ◽  
Alternative Routes ◽  
Control Pain

Several situations arise in the Pediatric Intensive Care Unit (PICU) patient which may require the pharmacologic control of pain and anxiety. The author discusses the various pharmacologic agents available for sedation and analgesia including the inhalational anesthetic agents, nitrous oxide, benzodiasepines, opioids, ketamine, propofol, and the barbiturates. While intravenous administration is generally chosen for the PICU patient, certain situations may arise which preclude this route. The available information concerning alternative routes of delivery for the various agents including subcutaneous and transmucosal administration is presented. The role of various regional anesthetic techniques to control pain in the PICU patient are reviewed.

A systematic approach to family engagement: Feasibility pilot of a pediatric delirium management and prevention toolkit

2019 ◽  
Vol 17 (1) ◽  
pp. 42-45 ◽  
Author(s):  
Gabrielle Silver ◽  
Chani Traube
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Improvement Project ◽  
The Family ◽  
Delirium Prevention ◽  
Delirium Management ◽  
Short And Long Term

AbstractObjectiveDelirium is a frequent and severe complication of serious pediatric illness. Development of a nonpharmacologic approach to prevent pediatric delirium may improve short- and long-term outcomes in children and their families. In this brief report, we describe the development of a quality improvement project designed to methodically promote the family member's engagement, comforting, and orienting activities with their critically ill child to decrease delirium rates.MethodWe created a developmentally specific Delirium Prevention Toolkit for families. In a feasibility pilot, March through June 2016, we offered the kit to 15 patients and their families. On discharge, families were asked to describe use of the toolkit and whether or not it was helpful for them.ResultsTwelve of 15 patients and families used various elements of the toolkit, particularly the headphones, music, and games; no one regularly used the blank journal. All reported that it was easy and helpful to have as support for their stay in the pediatric intensive care unit.Significance of resultsThis pilot demonstrated practicality of a nonpharmacologic delirium prevention toolkit in the pediatric intensive care unit, and satisfaction from patients and families.

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