SCCM Resource Library-Applying the ICU Liberation Bundle to Critically Ill Children

Pdf Summary

The document outlines the implementation of the ICU Liberation Bundle for pediatric intensive care units (PICUs), emphasizing the need for a structured approach to reduce the risks and adverse effects associated with critical pediatric care, such as post-intensive care syndrome. The ICU Liberation Initiative, introduced by the Society of Critical Care Medicine (SCCM), focuses on reducing harmful excesses in sedation, immobilization, and promoting beneficial practices like spontaneous breathing and early mobilization. 

Key components of the bundle include: 

1. <strong>Pain Management</strong>: Using objective tools like the FLACC scale to assess and manage pain with nonpharmacological and non-opioid interventions.
   
2. <strong>Spontaneous Awakening and Breathing Trials</strong>: Optimizing patient's sedation levels and conducting daily assessments for trials to minimize the duration of mechanical ventilation. 

3. <strong>Analgesia and Sedation Choices</strong>: Implementing a sedation strategy favoring lighter sedation using opioids and α2 agonists like dexmedetomidine over benzodiazepines to prevent delirium and improve sleep.

4. <strong>Delirium Assessment and Management</strong>: Regular monitoring using CAPD or pCAM-ICU tools paired with prevention strategies such as promoting day-night cycles.

5. <strong>Early Mobility</strong>: Promoting daily patient mobilization coordinated by an interprofessional team, starting from in-bed exercises to out-of-bed activities when feasible.

6. <strong>Family Engagement</strong>: Involving families in decision-making through structured rounds and conferences to enhance outcomes and minimize pharmacological interventions.

7. <strong>Sleep Hygiene</strong>: Managing sleep disturbances by adhering to sleep routines, minimizing disruptions, and using melatonin if necessary.

The document stresses the importance of using validated assessment tools, securing leadership support, and maintaining ongoing communication to ensure successful implementation. An emphasis is placed on continuous auditing and feedback to sustain improvements. The SCCM provides resources, such as a Minimum Data Set Toolkit and opportunities for education and hosting courses, to aid facilities in adopting the ICU Liberation practices effectively.

Asset Subtitle

Pediatrics, Quality and Patient Safety, 2020, 00:06:19

Asset Caption

This article was originally published in the Spring 2020 Issue of Critical Connections.

The aim of this article is to provide pediatric intensive care unit (PICU) practitioners with general guidance on implementation of the ICU Liberation Bundle. Learning from the adult collaborative efforts and single-center pediatric initiatives, the pediatric critical care community can use the following keys to success in their PICU liberation implementation journey (Table 1).

Critical Connections, the critical care industry's only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team.

Karen Choong, MB, BCh, FRCPC
Samer Abu-Sultaneh, MD, FAAP

Meta Tag

Content Type Article

Knowledge Area Pediatrics

Knowledge Area Quality and Patient Safety

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Guidelines

Tag Evidence Based Medicine

Year 2020

Keywords

ICU Liberation Bundle

pediatric intensive care

post-intensive care syndrome

sedation management

early mobilization

pain management

delirium assessment

family engagement

sleep hygiene

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