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

Background: The 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. Aim: The 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 Design: A 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. Results: Nurse-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. Conclusions: Nurse-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.