Yang Youyang, Geva Alon, Madden Kate, Mehta Nilesh M
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
Front Pediatr. 2022 Jul 4;10:864029. doi: 10.3389/fped.2022.864029. eCollection 2022.
Sedation and analgesia (SA) management is essential practice in the pediatric intensive care unit (PICU). Over the past decade, there has been significant interest in optimal SA management strategy, due to reports of the adverse effects of SA medications and their relationship to ICU delirium. We reviewed 13 studies examining SA practices in the PICU over the past decade for the purposes of reporting the study design, outcomes of interest, SA protocols used, strategies for implementation, and the patient-centered outcomes. We highlighted the paucity of evidence-base for these practices and also described the existing gaps in the intersection of implementation science (IS) and SA protocols in the PICU. Future studies would benefit from a focus on effective implementation strategies to introduce and sustain evidence-based SA protocols, as well as novel quasi-experimental study designs that will help determine their impact on relevant clinical outcomes, such as the occurrence of ICU delirium. Adoption of the available evidence-based practices into routine care in the PICU remains challenging. Using SA practice as an example, we illustrated the need for a structured approach to the implementation science in pediatric critical care. Key components of the successful adoption of evidence-based best practice include the assessment of the local context, both resources and barriers, followed by a context-specific strategy for implementation and a focus on sustainability and integration of the practice into the permanent workflow.
镇静与镇痛（SA）管理是儿科重症监护病房（PICU）的重要实践。在过去十年中，由于有报道称SA药物存在不良反应及其与ICU谵妄的关系，人们对最佳SA管理策略产生了浓厚兴趣。我们回顾了过去十年中13项关于PICU中SA实践的研究，目的是报告研究设计、感兴趣的结果、所使用的SA方案、实施策略以及以患者为中心的结果。我们强调了这些实践缺乏循证基础，并描述了PICU中实施科学（IS）与SA方案交叉领域中存在的差距。未来的研究将受益于专注于有效实施策略，以引入和维持基于证据的SA方案，以及新颖的准实验研究设计，这将有助于确定它们对相关临床结果的影响，如ICU谵妄的发生。将现有的循证实践应用于PICU的常规护理仍然具有挑战性。以SA实践为例，我们说明了儿科重症监护中实施科学需要一种结构化方法。成功采用循证最佳实践的关键要素包括评估当地情况，包括资源和障碍，然后是针对具体情况的实施策略，以及专注于可持续性并将该实践融入永久工作流程。
