Recomendaciones para la analgosedación en niños críticamente enfermos en general y con COVID19 Comité de Analgesia, Delirium y Sedación. Sociedad Argentina de Terapia Intensiva
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En las Unidades de Cuidado Intensivo Pediátricas (UCIPs), el adecuado manejo de la analgosedación cobra vital importancia, siendo necesario mantener al niño sin dolor y tranquilo. La valoración del dolor y la sedación debe ser una práctica rutinaria. Es fundamental conocer las drogas disponibles, el manejo correcto de la dosis, así como sus principales efectos adversos e interacciones. También es necesaria la detección precoz del delirium y del síndrome de abstinencia para asegurar una adecuada atención de calidad.
La actual pandemia de COVID 19 afecta de manera grave a una escasa proporción de la población pediátrica provocando la necesidad de su ingreso a terapia intensiva. Dada la gravedad de este cuadro como de otras entidades críticas, el empleo de una correcta analgesia y sedación juntamente con otras medidas terapéuticas, se impone fuertemente. Debido a todo lo expuesto se elaboraron las siguientes recomendaciones.
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Maluenda F, Aguilera P, Kripper C, et al. Secuencia rápida de intubación en el Servicio de Urgencia. Series Clínicas de Medicina de Urgencia. Revista Chilena de Medicina Intensiva 2015; 30(1): 23-32.
Lucas SS, Nasr VG, Ng AJ, et al. Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: pharmacotherapies in cardiac critical care: sedation, analgesia and muscle relaxant. Pediatr Crit Care Med 2016; 17(3 Suppl 1): S3-S15. https://doi.org/10.1097/PCC.0000000000000619
Playfor S, Jenkins I, Boyles C, et al. Consensus Guidelines on Sedation and Analgesia in Critically Ill Children. Intensive Care Med 2006; 32(8): 1125-1136. https://doi.org/10.1007/s00134-006-0190-x
Motta E, Luglio M, Figueiredo Delgado A, et al. Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit. Rev Assoc Med Bras 2016; 62(6): 602-609. https://doi.org/10.1590/1806-9282.62.06.602
Barr J, Fraser GL, Puntillo K, et al. Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Crit Care Med 2013; 41(1): 263-306. https://doi.org/10.1097/CCM.0b013e3182783b72
Zuppa AF, Curley MAQ. Sedation analgesia and neuromuscular blockade in pediatric critical care. Overview and current landscape. Pediatr Clin North Am 2017; 64(5): 1103-1116. https://doi.org/10.1016/j.pcl.2017.06.013
Vincent JL, Shehabi Y, Walsh T, et al. Comfort and patient centred care without excessive sedation: the eCASH concept. Intensive Care Med 2016; 42(6): 962-971. https://doi.org/10.1007/s00134-016-4297-4
Marra A, Ely W, Pandharipande PP, et al. The ABCDEF bundle in critical care. Crit Care Clin 2017; 33(2): 225-243. https://doi.org/10.1016/j.ccc.2016.12.005
Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2018; 46(9): e 825-e873. https://doi.org/10.1097/CCM.0000000000003299
Johansson M, Kokinsky E. The COMFORT Behavioral Scale and the Modified FLACC Scale in Paediatric Intensive Care. Nurs Crit Care 2009; 14(3): 122-130. https://doi.org/10.1111/j.1478-5153.2009.00323.x
Vet NJ, Kleiber N, Ista E, et al. Sedation in critically ill children with respiratory failure. Front Pediatr 2016; 4: 89. https://doi.org/10.3389/fped.2016.00089
Harris J, Ramelet AS, van Dijk M, et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals. Intensive Care Med 2016; 42(6): 972-986. https://doi.org/10.1007/s00134-016-4344-1
Walker T, Kudchadkar SR. Pain and Sedation Management: 2018 Update for the Rogers’ Textbook of Pediatric Intensive Care. Pediatr Crit Care Med 2019; 20(1): 54-61. https://doi.org/10.1097/PCC.0000000000001765
Cunningham ME, Vogel AM. Analgesia, sedation, and delirium in pediatric surgical critical care. Semin Pediatr Surg 2019; 28(1): 33-42. https://doi.org/10.1053/j.sempedsurg.2019.01.006
Glicksman Kerson A, DeMaria R, Mauer, et al. Validity of the Richmond Agitation-Sedation Scale (RASS) in critically ill children. J Intens Care 2016; 4: 65. https://doi.org/10.1186/s40560-016-0189-5
Bosch-Alcaraz A, Jordan I, Guardia Olmos J, et al. Transcultural adaptation and characteristics of the Spanish version of the COMFORT Behavior Scale in pediatric critical care patients. Medicina Intensiva 2019; S0210-5691(19)30180-9. https://doi.org/10.1016/j.medin.2019.07.001
Mencía S. Monitorización de analgesia, sedación y BNM en UCIP. Protocolo del grupo de sedoanalgesia de la SECIP. Disponible en: http://secip.com/wp-content/uploads/2018/06/Escalas-de-Sedoanalgesia-en-UCIP.pdf.
Keogh SJ, Long DA, Horn DV. Practice guidelines for sedation and analgesia management of critically ill children: a pilot study evaluating guideline impact and feasibility in the PICU. BMJ Open 2015; 5(3): e006428. https://doi.org/10.1136/bmjopen-2014-006428
Kongkiattikul L, Dagenais M, Ruo N, et al. The impact of a quality improvement project to standardize pain, agitation, and withdrawal assessments on the use of morphine and midazolam in the Pediatric Intensive Care Unit. Pediatr Anesth. 2019; 29(4): 322-330. https://doi.org/10.1111/pan.13591
Watson RS, Asaro LA, Hertzog JH, et al. Long-term outcomes after protocolized sedation versus usual care in ventilated pediatric patients. Am J Respir Crit Care Med 2018; 197(11): 1457-1467. https://doi.org/10.1164/rccm.201708-1768OC
Dreyfus L, Javouhey E, Denis A, et al. Implementation and evaluation of a paediatric nurse driven sedation protocol in a paediatric intensive care unit. Ann Intensive Care 2017; 7: 36. https://doi.org/10.1186/s13613-017-0256-7
Larson GE, Arnup SJ, Clifford M, Evans J. How does the introduction of a pain and sedation management-guideline in the paediatric intensive care impact on clinical practice. A comparison of audits pre and post guideline introduction. Aust Crit Care 2013; 26(3): 118-123. https://doi.org/10.1016/j.aucc.2013.04.001
Murray MJ, DeBlock H, Erstad B, et al. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient. Crit Care Med 2016; 44(11): 2079-2103. https://doi.org/10.1097/CCM.0000000000002027
Long D, Horn D, Keogh S. A survey of sedation assessment and management in Australian and New Zealand paediatric intensive care patients requiring prolonged mechanical ventilation. Aust Crit Care 2005; 18(4): 152-157. https://doi.org/10.1016/s1036-7314(05)80028-1
Mencía S, Botrán M, López-Herce J, del Castillo J, Grupo de estudio de Sedoanalgesia de la SECIP. Manejo de la sedoanalgesia y de los relajantes musculares en las unidades de cuidados intensivos pediátricos españolas. An. Pediatr (Barc) 2011; 74(6): 396-404. https://doi.org/10.1016/j.anpedi.2010.12.002
Blackwood B, Tume L. The implausibility of “usual care” in an open system: sedation and weaning practices in Paediatrics intensive Care Units (PICUs) in the United Kingdom (UK). Trials 2015; 16: 325. https://doi.org/10.1186/s13063-015-0846-3
García Guerra G, Joffe AR, Cave D, et al. Survey of sedation and analgesia practice among Canadian pediatric critical care physicians. Pediatr Crit care Med 2016; 17(9): 823-830. https://doi.org/10.1097/PCC.0000000000000864
Smith HAB, Gangopadhyay M, Goben CM, et al. The Preschool Confusion Assessment Method for the ICU: valid and reliable delirium monitoring for critically ill infants and children. Crit Care Med 2016; 44(3): 592–600. https://doi.org/10.1097/CCM.0000000000001428
Traube C, Silver G, Kearney J, et al. Cornell Assessment of Pediatric Delirium: A valid, rapid, observational tool for screening delirium in the PICU. Crit Care Med 2014; 42(3): 656-663. https://doi.org/10.1097/CCM.0b013e3182a66b76
Traube C, Silver G, Reeder W, et al. Pediatric delirium in critically-ill children: An International Point Prevalence Study. Crit Care Med 2017; 45(4): 584-590. https://doi.org/10.1097/CCM.0000000000002250
Dechnik A, Traube C. Delirium in hospitalised children. Lancet Child Adolesc Health 2020; 4(4): 312-321. https://doi.org/10.1016/S2352-4642(19)30377-3
www.icudelirium.org
Fernández-Carrión F, González-Salas E, Silver G, et al. Translation and cultural adaptation of Cornell Assessment of Pediatric Delirium to Spanish. Pediatr Crit Care Med 2019; 20(4): 400-402. https://doi.org/10.1097/PCC.0000000000001853
Figueroa-Ramos MI, Arroyo-Novoa CM, García-DeJesús RL, et al. Traducción y adaptación cultural al español del Preschool Confusion Assessment Method for the Intensive Care Unit. Med Intensiva 2019; S0210-5691(19)30177-9. https://doi.org/10.1016/j.medin.2019.06.007
Franco JG, Ricardo C, Muñoz JF, et al. Diagnosing delirium in critically ill children: Spanish translational cultural adaptation of the Pediatric Confusion Assessment Method for the Intensive Care Unit. Crit Care Med 2012; 40(3): 1034. https://doi.org/10.1097/CCM.0b013e31823c8b1c
Blair GJ, Mehmood T, Rudnick M, et al. Nonpharmacologic and medication minimization strategies for the prevention and treatment of ICU delirium: A narrative review. J Intensive Care Med 2019; 34(3): 183-190. https://doi.org/10.1177/0885066618771528
Campbell CT, Grey E, Munoz-Pareja J, et al. An evaluation of risperidone dosing for pediatric delirium in children less than or equal to 2 years of age. Ann Pharmacother 2020; 54(5): 464-469. https://doi.org/10.1177/1060028019891969
Kotfis K, Roberson SW, Wilson JE, et al. COVID-19: ICU delirium management during SARS-CoV-2 pandemic. Crit Care 2020; 24: 176. https://doi.org/10.1186/s13054-020-02882-x
Whelan KT, Heckmann MK, Lincoln PA, et al. Pediatric withdrawal identification and management. J Pediatr Intensive Care 2015; 4(2): 73-78. https://doi.org/10.1055/s-0035-1556749
Fenn NE. Opioid and benzodiazepine weaning in pediatric patients: Review of current literature. Pharmacotherapy 2017; 37(11): 1458-1468. https://doi.org/10.1002/phar.2026
Madden K, Burns MM, Tasker RC. Differentiating delirium from sedative/hypnotic-related iatrogenic withdrawal syndrome: lack of specificity in pediatric critical care assessment tools. Pediatr Crit Care Med 2017; 18(6): 580-588. https://doi.org/10.1097/PCC.0000000000001153
Amirnovin R, Sanchez-Pinto LN, Okuhara C, et al. Implementation of a risk-stratified opioid and benzodiazepine weaning protocol in a pediatric cardiac ICU. Pediatr Crit Care Med 2018; 19(11): 1024-1032. https://doi.org/10.1097/PCC.0000000000001719
Dominguez KD, Crowley MR, Coleman DM, et al. Withdrawal from lorazepam in critically iII children. Ann Pharmacother 2006; 40(6): 1035-1039. https://doi.org/10.1345/aph.1G701
Lazzeri M, Lanza A, Bellini R, et al. Respiratory phisiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Phisiotherapists (ARIR). Monaldi Arch Chest Dis 2020; 90(1): 1285. https://doi.org/10.4081/monaldi.2020.1285
Phua J, Weng L, Ling L, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med 2020: 8: 506-517. https://doi.org/10.1016/S2213-2600(20)30161-2
Solé G, Salort-Campana E, Pereon Y, et al. Guidance for the care of neuromuscular patients during the COVID-19 pandemic outbreak from the French Rare Health Care for Neuromuscular Diseases Network. Rev Neurol (Paris) 2020; 176(6): 507-515. https://doi.org/10.1016/j.neurol.2020.04.004
Pediatric and Neonatal Lexi-Drugs. LexiComp Online. Disponible en: http://online.lexi.com. (Consulta: mayo 2020).
IBM Micromedex® web application Access. Pediatrics and neofax. Disponible en: https://www.micromedexsolutions.com. (Consulta: mayo 2020).
Sasabuchi Y, Yasunaga H, Matsui H, et al. Prolonged propofol infusion for mechanically ventilated children. Anaesthesia 2016; 71(14): 424-428. https://doi.org/10.1111/anae.13401
Agudelo SC, Mencía S, Faro A, et al. Propofol en perfusión continua en niños en estado crítico. Med Intensiva 2012; 36(6): 410-415. https://doi.org/10.1016/j.medin.2011.11.018
Comité de Medicamentos de la Asociación Española de Pediatría. Pediamécum, 2015. Disponible en: https://www.aeped.es/comite-medicamentos/pediamecum. (Consulta: 24 de mayo, 2020).
Fernández F, Morales S. Sedoanalgesia en UCIP. Grupo de Sedoanalgesia de la Sociedad Española de Cuidados Intermedios en Pediatría.
Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure. Dosing Guidelines for Adults and Children. 5th ed. American College of Physicians; 2007.