Withdrawal assessment in the pediatric intensive care unit: quantifying a morbidity of pain and sedation management in the critically ill child.

摘要

The studies of Anand et al. (1,2) demonstrated that pain management in critically ill infants could reduce morbidity and mortality, and led to aggressive pain and sedation management in pediatric intensive care unit patients. However, a significant challenge remains, in part because of the difficulty in differentiating pain from anxiety in sick children. As the care team seeks observable comfort in the sickest children, physiologic tolerance is often an acute consequence of escalating dosages of opioids and sedatives. The long-term consequences are physiologic dependence, prolonged weaning periods and an increased incidence of withdrawal symptoms. Once dependence has developed, withdrawal symptoms will occur from abrupt discontinuation or rapid weaning of opioids and benzodiazepines.