Clinical recommendations for pain,
sedation, withdrawal and delirium assessment
in critically ill infants and children: an ESPNIC
position statement for healthcare professionals

Harris, J; Ramelet, A; van Dijk, M; Pokorna, P; Wielenga, J; Tume, LN; Tibboel, D; Ista, E

Abstract

Background: This position statement provides clinical recommendations for the assessment of pain, level of sedation,
iatrogenic withdrawal syndrome and delirium in critically ill infants and children. Admission to a neonatal or
paediatric intensive care unit (NICU, PICU) exposes a child to a series of painful and stressful events. Accurate assessment
of the presence of pain and non-pain-related distress (adequacy of sedation, iatrogenic withdrawal syndrome
and delirium) is essential to good clinical management and to monitoring the effectiveness of interventions to relieve
or prevent pain and distress in the individual patient.
Methods: A multidisciplinary group of experts was recruited from the members of the European Society of Paediatric
and Neonatal Intensive Care (ESPNIC). The group formulated clinical questions regarding assessment of pain
and non-pain-related distress in critically ill and nonverbal children, and searched the PubMed/Medline, CINAHL and
Embase databases for studies describing the psychometric properties of assessment instruments. Furthermore, level
of evidence of selected studies was assigned and recommendations were formulated, and grade or recommendations
were added on the basis of the level of evidence.
Results: An ESPNIC position statement was drafted which provides clinical recommendations on assessment of pain
(n = 5), distress and/or level of sedation (n = 4), iatrogenic withdrawal syndrome (n = 3) and delirium (n = 3). These
recommendations were based on the available evidence and consensus amongst the experts and other members of
ESPNIC.
Conclusions: This multidisciplinary ESPNIC position statement guides professionals in the assessment and reassessment
of the effectiveness of treatment interventions for pain, distress, inadequate sedation, withdrawal syndrome and
delirium.

Citation

position statement for healthcare professionals. Intensive Care Medicine, 42(6), 972-986. https://doi.org/10.1007/s00134-016-4344-1

• Journal Article Type: Article
• Acceptance Date: Mar 23, 2016
• Online Publication Date: Apr 15, 2016
• Publication Date: Apr 15, 2016
• Deposit Date: Sep 4, 2019
• Publicly Available Date: Sep 4, 2019
• Journal: Intensive Care Medicine
• Print ISSN: 0342-4642
• Electronic ISSN: 1432-1238
• Publisher: Springer Verlag
• Volume: 42
• Issue: 6
• Pages: 972-986
• DOI: https://doi.org/10.1007/s00134-016-4344-1
• Publisher URL: https://doi.org/10.1007/s00134-016-4344-1
• Related Public URLs: https://link.springer.com/journal/134