Evidence map›Paper›PMID 40438004›Full record

SynthesisNursing in critical care2025

Impact of Nurse-Driven Analgesia and Sedation Protocols on Medication Exposure and Withdrawal in Critically Ill Children: A Systematic Review.

Laura Schianchi, Julia Harris

Abstract readSystematic Review
In one paragraph

Synthesis in Nursing in critical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

2 authors.

Laura SchianchiPaediatric and Adult Congenital Heart Disease Centre, IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy.ORCID https://orcid.org/0009-0009-5864-9877
Julia HarrisDepartment of Children's Nursing, London South Bank University, London, UK.

Funding

Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato
6 · The paper itself

Abstract

backgroundThe administration of analgesia and sedation is essential for patients admitted to the paediatric intensive care unit (PICU). However, over-sedation can cause side effects, including iatrogenic withdrawal syndrome (IWS). The use of nurse-led analgesia and sedation protocols may improve patient outcomes.

aimThe primary aim of this systematic review was to determine whether the use of such protocols can reduce opioid and benzodiazepine doses. Secondary outcome measures included documentation of pain and sedation scores, incidence of IWS, duration of mechanical ventilation (MV) and PICU/hospital length of stay (LOS). STUDY

designA systematic review of the literature was conducted, searching several databases, including CINAHL, MEDLINE, Academic Search Complete and Cochrane Library. Pertinent articles were selected according to pre-determined eligibility criteria. The internal validity of included studies was assessed using validated critical appraisal tools for quantitative research from the Cochrane Library. Narrative synthesis was utilised for data analysis due to the heterogeneity of study characteristics.

resultsNurse-led protocolised sedation significantly reduced the administered doses of benzodiazepines and the incidence of IWS. Moreover, the use of protocols significantly improved the documentation of pain and sedation scores across included studies. No significant difference in opioid use, duration of MV, and PICU/hospital LOS has been found. However, sub-group analyses for duration of MV and PICU/hospital LOS showed positive results in older children and those post-cardiac surgery.

conclusionsNurse-driven analgesia and sedation protocols can reduce over-sedation and IWS in critically ill children. Further studies should explore the use of protocols in patient sub-groups where positive results have been reported. RELEVANCE TO CLINICAL PRACTICE: Nurse-led analgesia and sedation protocols in PICU can improve outcomes and reduce costs. Effective implementation requires training and audits to boost nurses' confidence and autonomy.

Indexed as

AnalgesiaCritical IllnessHypnotics and SedativesSubstance Withdrawal SyndromeAnalgesics, OpioidBenzodiazepinesChildClinical ProtocolsHumansIntensive Care Units, PediatricAnalgesics, OpioidBenzodiazepinesHypnotics and Sedativesanalgesia and sedation protocolbenzodiazepinesiatrogenic withdrawal syndrome (IWS)nurse‐driven protocolpaediatric intensive care unit (PICU)

Identifiers

PMID40438004
PMCPMC12120589

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.