Schianchi Laura, Harris Julia
Paediatric and Adult Congenital Heart Disease Centre, IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy.
Department of Children's Nursing, London South Bank University, London, UK.
Nurs Crit Care. 2025 May;30(3):e70051. doi: 10.1111/nicc.70051.
The administration of analgesia and sedation is essential for patients admitted to the paediatric intensive care unit (PICU). However, over-sedation can cause side effects, including iatrogenic withdrawal syndrome (IWS). The use of nurse-led analgesia and sedation protocols may improve patient outcomes.
The primary aim of this systematic review was to determine whether the use of such protocols can reduce opioid and benzodiazepine doses. Secondary outcome measures included documentation of pain and sedation scores, incidence of IWS, duration of mechanical ventilation (MV) and PICU/hospital length of stay (LOS).
A systematic review of the literature was conducted, searching several databases, including CINAHL, MEDLINE, Academic Search Complete and Cochrane Library. Pertinent articles were selected according to pre-determined eligibility criteria. The internal validity of included studies was assessed using validated critical appraisal tools for quantitative research from the Cochrane Library. Narrative synthesis was utilised for data analysis due to the heterogeneity of study characteristics.
Nurse-led protocolised sedation significantly reduced the administered doses of benzodiazepines and the incidence of IWS. Moreover, the use of protocols significantly improved the documentation of pain and sedation scores across included studies. No significant difference in opioid use, duration of MV, and PICU/hospital LOS has been found. However, sub-group analyses for duration of MV and PICU/hospital LOS showed positive results in older children and those post-cardiac surgery.
Nurse-driven analgesia and sedation protocols can reduce over-sedation and IWS in critically ill children. Further studies should explore the use of protocols in patient sub-groups where positive results have been reported.
Nurse-led analgesia and sedation protocols in PICU can improve outcomes and reduce costs. Effective implementation requires training and audits to boost nurses' confidence and autonomy.
对于入住儿科重症监护病房（PICU）的患者，给予镇痛和镇静治疗至关重要。然而，过度镇静会导致副作用，包括医源性戒断综合征（IWS）。采用护士主导的镇痛和镇静方案可能会改善患者的治疗效果。
本系统评价的主要目的是确定使用此类方案是否可以减少阿片类药物和苯二氮䓬类药物的剂量。次要结局指标包括疼痛和镇静评分的记录、IWS的发生率、机械通气（MV）时间以及PICU/住院时间（LOS）。
对文献进行系统评价，检索了多个数据库，包括护理学与健康领域数据库（CINAHL）、医学文献数据库（MEDLINE）、学术搜索完整版数据库（Academic Search Complete）和考克兰图书馆（Cochrane Library）。根据预先确定的纳入标准选择相关文章。使用考克兰图书馆经过验证的定量研究批判性评价工具评估纳入研究的内部效度。由于研究特征的异质性，采用叙述性综合分析进行数据分析。
护士主导的程序化镇静显著降低了苯二氮䓬类药物的给药剂量和IWS的发生率。此外，在纳入的研究中，使用方案显著改善了疼痛和镇静评分的记录。在阿片类药物使用、MV时间以及PICU/住院时间方面未发现显著差异。然而，对MV时间和PICU/住院时间的亚组分析显示，在年龄较大的儿童和心脏手术后的儿童中结果呈阳性。
护士主导的镇痛和镇静方案可以减少危重症儿童的过度镇静和IWS。进一步的研究应探索在已报告有阳性结果的患者亚组中使用该方案。
PICU中护士主导的镇痛和镇静方案可以改善治疗效果并降低成本。有效的实施需要培训和审核，以增强护士的信心和自主性。
