Guideline sources The following summarized guidelines for the evaluation and management of pediatric critical care are prepared by our editorial team based on guidelines from the Society of Critical Care Medicine (SCCM 2022). 1 Guidelines 1. Diagnostic investigations Assessment of pain: consider obtaining routine pain assessment via self-report using the Visual Analog Scale, NRS, Oucher Scale, or Wong-Baker Faces pain scale in critically ill pediatric patients aged 6 years capable of communicating. C Show 3 more Assessment of sedation: Use the COMFORT-B scale or thr State Behavioral Scale to assess level of sedation in mechanically ventilated pediatric patients. B Consider using the Richmond Agitation-Sedation Scale to assess level of sedation in mechanically ventilated pediatric patients. C Assessment of delirium: Use the preschool and pediatric Confusion Assessment Methods for the ICU or the Cornell Assessment for Pediatric Delirium as the most valid and reliable delirium monitoring tools in critically ill pediatric patients. A Obtain routine screening for ICU delirium using a validated tool in critically ill pediatric patients upon admission through ICU discharge or transfer. A https://web.pathway.md/diseases/reci5wqxmhtsYwXaC 1/3 6/29/23, 10:56 PM Pediatric critical care Pathway Assessment of iatrogenic withdrawal syndrome: use either the Withdrawal Assessment Tool-1 or Sophia Observation Scale for the assessment of iatrogenic withdrawal syndrome due to opioid or benzodiazepine withdrawal in critically ill pediatric patients. B Show 2 more 2. Medical management Analgesia: administer IV opioids as the primary analgesic for the treatment of moderate-to- severe pain in critically ill pediatric patients. B Show 6 more Sedation: consider assigning all pediatric patients requiring mechanical ventilation a target depth of sedation using a validated sedation assessment tool at least once daily. C Show 9 more Neuromuscular blockage: consider obtaining train-of-four monitoring in concert with clinical assessment to determine depth of neuromuscular blockade. C Show 4 more Management of delirium: Consider adopting the following nonpharmacologic strategies in critically ill pediatric patients, given low patient risk, and possible patient benefit to reduce the incidence and/or decrease duration or severity of delirium: optimization of sleep hygiene use of interdisciplinary rounds family engagement on rounds family involvement with direct-patient care. C Show 6 more Management of iatrogenic withdrawal syndrome: consider administering opioid replacement therapy in pediatric patients with opioid-related iatrogenic withdrawal syndrome, to attenuate symptoms, irrespective of preceding dose and/or duration or opioid exposure. C Show 3 more 3. Inpatient care Optimization of inpatient care: consider facilitating parental or caregiver presence in the pediatric ICU during routine care and interventional procedures in order to provide comfort to the patients, decrease parental levels of stress and anxiety, and increase level of satisfaction of care. C Show 4 more References 1. Heidi A B Smith, James B Besunder, Kristina A Betters et al. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatr Crit Care Med. 2022 Feb 1;23 2):e74-e110. Open https://web.pathway.md/diseases/reci5wqxmhtsYwXaC 2/3 6/29/23, 10:56 PM Pediatric critical care Pathway 2. Davidson JE, Aslakson RA, Long AC et al. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU. Crit Care Med. 2017 Jan;45 1 103 128. Open https://web.pathway.md/diseases/reci5wqxmhtsYwXaC 3/3