Att minska abstinens inom barnintensivvården

Abstract

Background Children who are being treated in the intensive care unit need analgesia and sedation, often as continuous infusions for more than three days. The problem with many of these medications, such as opioids and bensodiazepines is that they can create an addiction in a short period of time. Later on, when these medications are removed, the patient often suffers from withdrawal, which creates a suffering for the patient. Aim To illustrate strategies for reducing withdrawal in the pediatric intensive care. Method A systematic literature review with quantitative data was conducted. Twelve articles were identified for this review. Results Three themes were discovered; Tapering the existing medication, tapering using another medication and the intensive care nurse’s knowledge about withdrawal symptoms. Discussion Several strategies were found to avoid withdrawal within the pediatric intensive care and several factors seem to be effective in reducing the patients suffering. Both pharmacological adjustments of the sedation and analgesia and the use of certain forms that can contribute to an increase in the nurse’s presence with the patient. These forms could also be seen as an aid for the more recently graduated intensive care nurses in their process of learning to understand how children react to withdrawal. Conclusion Lower doses of opioids and benzodiazepines seem to reduce the frequency of withdrawal and suffering for the patient. This can be achieved with a targeted sedation level using the COMFORT scale and/or the adding of Clonidine or Dexmedetomidine. The use of certain forms could also help increase the level of nurse presence with the patient, which could result in reduced suffering.