Critically Ill Infants and Children Clinical Practice Guidelines (SCCM, 2022)

Society of Critical Care Medicine

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

March 01, 2022

Guidelines for the prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility (PANDEM) were published in February 2022 by the Society for Critical Care Medicine (SCCM) in Pediatric Critical Care Medicine.[1]


IV opioids are recommended as the primary analgesic for treating moderate-to-severe pain in critically ill pediatric patients.

Adding an adjunct nonsteroidal anti-inflammatory drug (NSAID) (IV or oral) to improve early postoperative analgesia in critically ill pediatric patients is recommended.

Music therapy to augment analgesia is recommended for critically ill postoperative pediatric patients.

Nonnutritive sucking with oral sucrose should be offered to neonates and infants (< 12 mo old) prior to performing invasive procedures.


The Comfort-B Scale or the State Behavioral Scale (SBS) should be used to assess level of sedation in mechanically ventilated pediatric patients.

Consider dexmedetomidine as a primary agent for sedation in critically ill pediatric postoperative cardiac surgical patients with expected early extubation.

Neuromuscular Blockade

Routine use of passive eyelid closure and eye lubrication for the prevention of corneal abrasions is recommended in critically ill pediatric patients receiving neuromuscular blocking agents (NMBAs).


Consider minimizing benzodiazepine-based sedation when feasible in critically ill pediatric patients to decrease occurrence rate and/or duration or severity of delirium.

A baseline ECG followed by routine electrolyte and QTc interval monitoring are recommended for patients receiving haloperidol or atypical antipsychotics.


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