Evidence-based clinical guidelines on analgesia and sedation in newborn infants undergoing assisted ventilation and endotracheal intubation.
Acta paediatrica (Oslo, Norway · 2018-10-06 · Guideline / consensus
Abstract
AIM: This review informed pain control guidelines for clinicians performing mechanical ventilation, nasal continuous positive airway pressure and endotracheal intubation on term and preterm newborn infants. METHODS: We reviewed literature published between 1986 and June 2017 on analgesia and sedation during assisted ventilation and before endotracheal intubation in newborn infants admitted to neonatal intensive care units. The subsequent guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Our review produced five strong standard of care recommendations. One, reduce neonatal stress and use nonpharmacological analgesia during invasive ventilation. Two, favour intermittent boluses of opioids, administered after pain scores and before invasive procedures, during short expected periods of mechanical ventilation, mainly in preterm infants affected by respiratory distress syndrome. Three, do not use morphine infusion in preterm infants under 27 gestational weeks. Four, always use algometric scores to titrate analgesic drugs doses. Five, use premedication before endotracheal intubation for a more rapid, less painful, less traumatic and safer manoeuvre. We also developed 30 conditional recommendations on therapeutic options. CONCLUSION: Our review produced 35 recommendations on standard care and therapeutic options relating to the analgesia and sedation of newborn infants during ventilation and before endotracheal intubation.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Analgesics · Endotracheal intubation · Mechanical ventilation · Morphine · Neonates
Related articles
- Tracheal intubation and ventilation of the newborn infant. ARC and NZRC Guideline 2010. (Emerg Med Australas, 2011)
- Nasal versus oral intubation for mechanical ventilation of newborn infants. (Cochrane Database Syst Rev, 2000)
- High-dose intravenous isosorbide-dinitrate is safer and better than Bi-PAP ventilation combined with conventional treatment for severe pulmonary edema. (J Am Coll Cardiol, 2000)
- Case-control study of respiratory dynamic compliance in mechanically ventilated near-term newborns in a pre-hospital setting. (Intensive Care Med, 2011)
- Premedication for intubation with morphine causes prolonged depression of electrocortical background activity in preterm infants. (Pediatr Res, 2013)
- Premedication with intravenous midazolam for neonatal endotracheal intubation: A double blind randomized controlled trial. (J Res Med Sci, 2021)