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Sedation Guidelines, Protocols, and Algorithms in PICUs

A Systematic Review

Poh, Ya Nee BSc(Hons)1; Poh, Pei Fen BN1; Buang, Siti Nur Hanim MB BCh, MRCPCH2; Lee, Jan Hau MBBS, MRCPCH, MCI2,3

Pediatric Critical Care Medicine: November 2014 - Volume 15 - Issue 9 - p 885–892
doi: 10.1097/PCC.0000000000000255
Review Article

Objective: To evaluate the impact of sedation guidelines, protocols, and algorithms on clinical outcomes in PICUs.

Data Sources: CINAHL, Medline, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews,

Study Selection: English-only publications from 1966 to December 2013, which included keywords “sedation,” ”guideline,” “algorithm,” “protocol,” and “pediatric intensive care.” We included all primary studies involving critically ill children on sedation guidelines, protocols, and algorithms and excluded those which focused mainly on diagnostic or procedural purposes.

Data Extraction: Two authors independently screened each article for inclusion. A standardized data extraction sheet was used to extract data from all included studies.

Data Synthesis: Among the 1,283 citations yielded from our search strategy, six observational studies were included in the final review. Due to the heterogeneity of the studies included, clinical outcomes were not combined into a meta-analysis. A descriptive account of the studies was formulated to characterize all included studies. The three outcomes of interest were clinical outcomes, patients’ comfort and safety, and sedative use. We found an association between the use of sedation guidelines, protocols, and algorithms and reduced PICU length of stay, frequency of unplanned extubation, prevalence of patients experiencing drug withdrawal, total sedation duration, and doses. Overall, the quality of identified studies is low.

Conclusions: Despite widespread recommendation for the use of sedation guidelines, protocols, and algorithms in critically ill children, our systematic review revealed a paucity of high-quality evidence to guide this practice. More robust studies are urgently needed for this important aspect of PICU care.

1Division of Nursing, Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore.

2Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children Hospital, Singapore.

3Office of Clinical Sciences, Duke-NUS Graduate School of Medicine, Singapore.

Drs. Ya Nee Poh, Pei Fen Poh, and Buang are employed by KK Women's and Children's Hospital. Dr. Lee is employed by KK Women's and Children's Hospital. Her institution received grant support from the Khoo Foundation, Singapore.

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©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies