Amigoni Angela, Conti Giorgio, Conio Alessandra, Corno Manuela, Fazio Paola Claudia, Ferrero Federica, Gentili Marta, Giugni Cristina, L'Erario Manuela, Masola Maristella, Moliterni Paola, Pagano Giuseppe, Ricci Zaccaria, Romagnoli Stefano, Vasile Beatrice, Vitale Francesca, Marinosci Geremia Zito, Mondardini Maria Cristina
University Hospital, Via Giustiniani 3, 35128, Padova, Italy.
Catholic A. Gemelli University Hospital Roma, Rome, Italy.
J Anesth Analg Crit Care. 2022 Feb 12;2(1):9. doi: 10.1186/s44158-022-00036-9.
We aim to develop evidence-based recommendations for intensivists caring for children admitted to intensive care units and requiring analgesia and sedation. A panel of national paediatric intensivists expert in the field of analgesia and sedation and other specialists (a paediatrician, a neuropsychiatrist, a psychologist, a neurologist, a pharmacologist, an anaesthesiologist, two critical care nurses, a methodologist) started in 2018, a 2-year process. Three meetings and one electronic-based discussion were dedicated to the development of the recommendations (presentation of the project, selection of research questions, overview of text related to the research questions, discussion of recommendations). A telematic anonymous consultation was adopted to reach the final agreement on recommendations. A formal conflict-of-interest declaration was obtained from all the authors. Eight areas of direct interest and one additional topic were considered to identify the best available evidence and to develop the recommendations using the Evidence-to-Decision framework according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. For each recommendation, the level of evidence, the strength of the recommendation, the benefits, the harms and the risks, the benefit/harm balance, the intentional vagueness, the values judgement, the exclusions, the difference of the opinions, the knowledge gaps, and the research opportunities were reported. The panel produced 17 recommendations. Nine were evaluated as strong, 3 as moderate, and 5 as weak. Conclusion: a panel of national experts achieved consensus regarding recommendations for the best care in terms of analgesia and sedation in critically ill children.
我们旨在为重症监护病房中需要镇痛和镇静的儿童患者的重症监护医生制定基于证据的建议。一个由镇痛和镇静领域的全国儿科重症监护专家以及其他专家（一名儿科医生、一名神经精神科医生、一名心理学家、一名神经科医生、一名药理学家、一名麻醉师、两名重症监护护士、一名方法学家）组成的小组于2018年启动了一个为期两年的过程。三次会议和一次基于电子的讨论专门用于制定这些建议（项目介绍、研究问题的选择、与研究问题相关文本的概述、建议的讨论）。采用远程匿名咨询以就建议达成最终共识。所有作者均进行了正式的利益冲突声明。考虑了八个直接相关领域和一个额外主题，以识别最佳现有证据，并根据推荐分级评估、制定和评价（GRADE）方法，使用证据到决策框架来制定建议。对于每条建议，报告了证据水平、建议强度、益处、危害和风险、利弊平衡、故意模糊性、价值判断、排除因素、意见分歧、知识差距和研究机会。该小组提出了17条建议。九条被评估为强烈，三条为中等，五条为微弱。结论：一个全国专家小组就危重症儿童镇痛和镇静方面的最佳护理建议达成了共识。
