Adapting Evidence-Based Practice Guidelines for Sedation, Analgesia, Withdrawal, and Delirium Assessment and Management in Critically Ill Children.

OBJECTIVES

To adapt evidence-based clinical practice guidelines (CPGs) for sedation, analgesia, withdrawal, and delirium assessment and management with a focus on early mobility in critically ill children admitted to a pediatric intensive care unit (PICU).

DESIGN

The panel included two groups: the guideline adaptation group (GAG), which consisted of two consultant pediatric intensivists, a clinical pharmacist, a senior nurse specialist, and a general pediatrician and a CPG methodologist, and an external review and consultation group, which included five consultant pediatric intensivists, a clinical pharmacist, and two CPG expert physicians. A formal methodology for CPG adaptation was followed and included three phases: set-up, adaptation, and finalization.

RESULTS

The provided assessment tools and management algorithms focused on adequacy of sedation and analgesia, medication selection, dosing, initiation, and adjustment for both noninvasive and invasive mechanical ventilation; withdrawal assessment; weaning of sedation and analgesia; withdrawal management; delirium screening; delirium management; as well as early mobility facilitation. Implementation tools included behavioral scoring tool for sedation and pain, Withdrawal Assessment Tool with a management guide, screening score for delirium with a management guide, 3 clinical management algorithms for sedation management, analgesia management, and weaning process.

CONCLUSIONS

Based on a systematic adaptation framework and the interdisciplinary and multidisciplinary approach, the present study formulated an adapted CPG with practically applicable implementation tools and management algorithms that might help standardize sedation, analgesia, and withdrawal assessment and management in critically ill children at the PICU. We recommend further studies to clarify the generalizability, impact of its implementation, and practices to overcome potential barriers.