Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Jun;42(6):972-86.
doi: 10.1007/s00134-016-4344-1. Epub 2016 Apr 15.

Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals

Julia Harris  1 , Anne-Sylvie Ramelet  2 , Monique van Dijk  3   4 , Pavla Pokorna  3   5   6 , Joke Wielenga  7 , Lyvonne Tume  8 , Dick Tibboel  3 , Erwin Ista  9
Affiliations
Review

Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals

Julia Harris et al. Intensive Care Med. 2016 Jun.

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.

Keywords: Assessment; Delirium; Distress; Pain; Sedation; Withdrawal syndrome.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Overlap of behavioural cues in pain, sedation, withdrawal syndrome and delirium
Fig. 2
Fig. 2
Interpretation of pain and non-pain-related distress in critically ill children, based on van Dijk et al. 2012 [16]
See this image and copyright information in PMC

References

    1. Twite MD, Rashid A, Zuk J, Friesen RH. Sedation, analgesia, and neuromuscular blockade in the pediatric intensive care unit: survey of fellowship training programs. Pediatr Crit Care Med. 2004;5:521–532. doi: 10.1097/01.PCC.0000144710.13710.2E. - DOI - PubMed
    1. Ng E, Taddio A, Ohlsson A (2012) Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit. Cochrane Database Syst Rev 6:CD002052 - PubMed
    1. Carbajal R, Eriksson M, Courtois E, Boyle E, Avila-Alvarez A, Andersen RD, Sarafidis K, Polkki T, Matos C, Lago P, Papadouri T, Montalto SA, Ilmoja ML, Simons S, Tameliene R, van Overmeire B, Berger A, Dobrzanska A, Schroth M, Bergqvist L, Lagercrantz H, Anand KJ, EUROPAIN Survey Working Group Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study. Lancet Respir Med. 2015;3:796–812. doi: 10.1016/S2213-2600(15)00331-8. - DOI - PubMed
    1. Kidder C. Reestablishing health: factors influencing the child’s recovery in pediatric intensive care. J Pediatr Nurs. 1989;4:96–103. - PubMed
    1. Anand KJ, Willson DF, Berger J, Harrison R, Meert KL, Zimmerman J, Carcillo J, Newth CJ, Prodhan P, Dean JM, Nicholson C. Tolerance and withdrawal from prolonged opioid use in critically ill children. Pediatrics. 2010;125:e1208–e1225. doi: 10.1542/peds.2009-0489. - DOI - PMC - PubMed

MeSH terms

Substances