2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility
Pediatric Critical Care Medicine
Smith, H. A. B., Besunder, J. B., et al. (2022).
Pediatric Critical Care Medicine, 23(2), e74-e110.
This guideline provides recommendations for sedation, pain, and delirium management in critically ill infants and children in the pediatric intensive care unit (PICU) setting. While this guideline includes information on both pharmacological and non-pharmacological care, this summary highlights non-pharmacological recommendations within the scope of speech-language pathologists as members of the multidisciplinary treatment team.
Society of Critical Care Medicine
<div>Critically ill children in the PICU should be routinely screened for delirium using a validated tool. Screening should occur from admission to discharge or transfer (Strong Recommendation, High Level of Evidence). It is recommended that clinicians use the Cornell Assessment for Pediatric Delirium (CAPD) or the preschool and pediatric versions of the Confusion Assessment Methods for the ICU (psCAM-ICU and pCAM-ICU) to screen for delirium in this population (Strong Recommendation, High Level of Evidence).</div>
<div>Clinicians should consider multicomponent delirium programs using the following non-pharmacological strategies to reduce the occurrence, duration, or severity of delirium in critically ill children in the PICU:</div>
<ul>
<li><span style="color: #333333;">optimizing sleep hygiene through environmental (e.g., reducing night-time light and noise) strategies;</span></li>
<li><span style="color: #333333;">providing cognitive stimulation and physical activity during the day; </span></li>
<li><span style="color: #333333;">performing interdisciplinary rounds; </span></li>
<li><span style="color: #333333;">engaging directly with families during rounds; </span></li>
<li><span style="color: #333333;">involving families with routine care and interventional procedures in order to provide comfort to the child, decrease care provider anxiety and stress, and increase care satisfaction; and </span></li>
<li><span style="color: #333333;">providing noise reducing devices (e.g., ear plugs, headphones) to reduce the impact of non-modifiable ambient noise (Conditional Recommendation, Low Level of Evidence). </span></li>
</ul>
<div><span style="color: #333333;">Clinicians in the PICU should encourage early mobilization whenever feasible and should use standardized early mobilization protocols that are guided by the multidisciplinary team and family decision-making. These protocols should clearly outline readiness criteria</span><span style="color: #333333;">, contraindications, developmentally appropriate mobility activities/goals, and variables to monitor for safety and tolerance of activities (Conditional Recommendation, Low Level of Evidence).</span></div>
