The Society of Critical Care Medicine has issued a new practice guideline for the prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility (PANDEM).1 The guideline, created by an interprofessional writing panel of 29 national experts, provides 44 clinical recommendations on the basis of relevant literature over the past 30 years and five good practice statements (GPS) where indirect evidence supported benefit with minimal or no harm. The PANDEM recommendations provide detailed guidance on the routine monitoring of pain, agitation, delirium, and iatrogenic withdrawal from opioids and benzodiazepines using validated tools; use of protocols to guide use of sedation and analgesia; and importance of nonpharmacologic interventions in optimizing the ICU environment, such as family presence, sleep hygiene, and early mobility in improving patient comfort. The guideline also identifies gaps in the current literature to serve as a stimulus for future research.
The three clinical pharmacists on the PANDEM writing panel were ACCP members Peter N. Johnson, Pharm.D., FCCM, FPPA, FASHP, BCPS, BCPPS; Elizabeth A. Farrington, Pharm.D., FCCP, FCCM, FPPA, BCPS; and Cassandra A. Ruggles, Pharm.D., BCCCP, BCPPS. Johnson, a professor and president’s associate presidential professor at the University of Oklahoma Health Sciences Center College of Pharmacy, serves as director for both the pediatric pharmacotherapy degree option program and the PGY2 pediatric pharmacy residency. Farrington, currently ACCP president-elect, is a pediatric clinical pharmacist at the New Hanover Regional Medical Center Betty H. Cameron Women’s & Children’s Hospital in Wilmington, North Carolina. Ruggles is the pediatric ICU clinical coordinator at Akron Children’s Hospital. All three authors have significantly contributed to the body of knowledge in pediatric pain management and critical care. ACCP appreciates their work in developing this new treatment guideline and their dedication to optimizing the care of children requiring intensive care.
- Smith HAB, Besunder JB, Betters KA, 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;23:e74-e110.