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Children’s Healthcare Canada Knowledge Exchange Network (KEN)
May 5 @ 11:00 am - 12:00 pm
Comfort in pediatric critical care: a challenging new priority in the management of pediatric critical illness
Historically children admitted to the Pediatric Intensive Care Unit (PICU) were deeply sedated throughout much of their PICU Stay. However, with the recognition of the presence of PICU delirium in 25-60% of children admitted to a pediatric critical care unit we have had to re-evaluate our use of sedating medications and deep sedation in the care of these children.
PICU delirium is associated with negative short and long term outcomes and one of the main contributors to PICU delirium is deep sedation and exposure to sedating medications such as benzodiazepines. Thus, one of the main methods to decrease rates of delirium has been the implementation of ICU bundles of care to minimize sedation and normalize care of children in the PICU. We now allow children to be more awake and participate in care more while in the PICU. This new practice comes with it a significant challenge. We must ensure that we continue to optimize children’s comfort while also minimizing their exposure to harmful analgesic and sedative medications.
In order to achieve this, the PICU at Alberta Children’s Hospital in collaboration with PICUs across Canada and adult ICUs across Alberta implemented a Pain, Agitation and Delirium program. This program was a bundle of care that followed the ABCDEF bundle set out by the Society of Critical Care Medicine and was adapted to our pediatric population.
One of the key components of this bundle was ensuring the comfort of our patients. This included the implementation of q4h pain scoring, and a pain-first comfort pathway with a focus on non pharmacologic therapy and targeted comfort management. Through implementation of this program we have significantly improved our assessment and management of comfort of children admitted to our PICU. We continue to grow our program adding to new initiatives regularly as evidence evolves in this rapidly changing area.
1- Summarize what is known about the impact of the pandemic hospital policies on Canadian families of infants in the NICU.
2- Examine the evidence-based recommendations presented by the International Family Integrated care steering committee on how best to support parents of infants in the NICU during the pandemic.
3- Develop plans to evaluate their own NICU policies in light of the information provided