Sedative weaning and discontinuation in pediatric critical care: a scoping review
Caldwell D, James M, Raja P, Duffett M
Aims & Objectives
Discontinuing sedatives in children after critical illness is often challenging. Our objective in this scoping review was to identify and characterize the published literature focusing on sedative weaning and discontinuation in pediatric critical care – to understand the current research landscape, identify research gaps, and inform future systematic reviews.
We searched MEDLINE (inception to November 2017), including all types of publications in English that focused on sedative weaning and discontinuation in critically ill children. Pairs of reviewers independently screened studies for eligi- bility and abstracted data.
We included 154 publications from 14 countries published in 66 journals. Sedative weaning or discontinuation was a major focus in 97 (63%) of the publications. The literature has grown from 1 publication in 1989 to 19 in 2017. 105 (68%) were original research, while 32% were reviews and editorials. There were 2 randomized trials that focused solely on sedative weaning and discontinuation. The publications clustered in 7 themes: strategies for sedative withdrawal management (64 [42%]), characterization of withdrawal symptoms (37 [24%]), topic overviews (29 [19%]), practice evaluation (12 [8%]), assessment tools (10 [6%]), patient or family impact (1 [1%]), and clinician attitudes (1 [1%]). Of the publications that specified author designation, 62 (54%) were from two or more professions, the remaining were authored by a single profession, most frequently physicians (34 [22%]).
The published body of literature on weaning and discontinuation of sedatives is diverse, increasing, and evolving. Researchers can use this scoping review to identify gaps in current literature and priorities for future research.