TY - JOUR
T1 - Assessment and management of iatrogenic withdrawal syndrome and delirium in pediatric intensive care units across Europe
T2 - An ESPNIC survey
AU - the Analgosedation CONSORTIUM on behalf of the Pharmacology Section and the Nurse Science Section of the European Society of Paediatric and Neonatal Intensive Care
AU - Sperotto, Francesca
AU - Ramelet, Anne Sylvie
AU - Daverio, Marco
AU - Mondardini, Maria Cristina
AU - von Borell, Florian
AU - Brenner, Sebastian
AU - Tibboel, Dick
AU - Ista, Erwin
AU - Pokorna, Paula
AU - Amigoni, Angela
AU - Kola, Ermira
AU - Vittinghoff, Maria
AU - Duval, Els
AU - Polić, Branka
AU - Valla, Frederic
AU - Neunhoeffer, Felix
AU - Konstantinos, Tziouvas
AU - Györgyi, Zoltán
AU - Tan, Mong Hoi
AU - Hasani, Antigona
AU - Poluzioroviene, Edita
AU - Balmaks, Reinis
AU - Afanetti, Mickael
AU - Bentsen, Gunnar
AU - Bartkowska-Sniatkowska, Alicja
AU - Camilo, Cristina
AU - Simic, Dusica
AU - López-Fernández, Yolanda M.
AU - Mattsson, Janet
AU - Özen, Hasan
AU - Dmytriiev, Dmytro
AU - Manning, Joseph C.
AU - Tekgüç, Hakan
N1 - Funding Information:
We deeply thank all the PICU providers who responded to this survey, contributing to gaining important and up-to-date knowledge in the field. We thank the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) for the intellectual support.
Publisher Copyright:
© 2023 Pharmacotherapy Publications, Inc.
PY - 2023/8
Y1 - 2023/8
N2 - Introduction: Analgesia and sedation are essential for the care of children in the pediatric intensive care unit (PICU); however, when prolonged, they may be associated with iatrogenic withdrawal syndrome (IWS) and delirium. We sought to evaluate current practices on IWS and delirium assessment and management (including non-pharmacologic strategies as early mobilization) and to investigate associations between the presence of an analgosedation protocol and IWS and delirium monitoring, analgosedation weaning, and early mobilization. Methods: We conducted a multicenter cross-sectional survey-based study collecting data from one experienced physician or nurse per PICU in Europe from January to April 2021. We then investigated differences among PICUs that did or did not follow an analgosedation protocol. Results: Among 357 PICUs, 215 (60%) responded across 27 countries. IWS was systematically monitored with a validated scale in 62% of PICUs, mostly using the Withdrawal Assessment Tool-1 (53%). The main first-line treatment for IWS was a rescue bolus with interruption of weaning (41%). Delirium was systematically monitored in 58% of PICUs, mostly with the Cornell Assessment of Pediatric Delirium scale (48%) and the Sophia Observation Scale for Pediatric Delirium (34%). The main reported first-line treatment for delirium was dexmedetomidine (45%) or antipsychotic drugs (40%). Seventy-one percent of PICUs reported to follow an analgosedation protocol. Multivariate analyses adjusted for PICU characteristics showed that PICUs using a protocol were significantly more likely to systematically monitor IWS (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.01–3.67) and delirium (OR 2.00, 95% CI 1.07–3.72), use a protocol for analgosedation weaning (OR 6.38, 95% CI 3.20–12.71) and promote mobilization (OR 3.38, 95% CI 1.63–7.03). Conclusions: Monitoring and management of IWS and delirium are highly variable among European PICUs. The use of an analgosedation protocol was associated with an increased likelihood of monitoring IWS and delirium, performing a structured analgosedation weaning and promoting mobilization. Education on this topic and interprofessional collaborations are highly needed to help reduce the burden of analgosedation-associated adverse outcomes.
AB - Introduction: Analgesia and sedation are essential for the care of children in the pediatric intensive care unit (PICU); however, when prolonged, they may be associated with iatrogenic withdrawal syndrome (IWS) and delirium. We sought to evaluate current practices on IWS and delirium assessment and management (including non-pharmacologic strategies as early mobilization) and to investigate associations between the presence of an analgosedation protocol and IWS and delirium monitoring, analgosedation weaning, and early mobilization. Methods: We conducted a multicenter cross-sectional survey-based study collecting data from one experienced physician or nurse per PICU in Europe from January to April 2021. We then investigated differences among PICUs that did or did not follow an analgosedation protocol. Results: Among 357 PICUs, 215 (60%) responded across 27 countries. IWS was systematically monitored with a validated scale in 62% of PICUs, mostly using the Withdrawal Assessment Tool-1 (53%). The main first-line treatment for IWS was a rescue bolus with interruption of weaning (41%). Delirium was systematically monitored in 58% of PICUs, mostly with the Cornell Assessment of Pediatric Delirium scale (48%) and the Sophia Observation Scale for Pediatric Delirium (34%). The main reported first-line treatment for delirium was dexmedetomidine (45%) or antipsychotic drugs (40%). Seventy-one percent of PICUs reported to follow an analgosedation protocol. Multivariate analyses adjusted for PICU characteristics showed that PICUs using a protocol were significantly more likely to systematically monitor IWS (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.01–3.67) and delirium (OR 2.00, 95% CI 1.07–3.72), use a protocol for analgosedation weaning (OR 6.38, 95% CI 3.20–12.71) and promote mobilization (OR 3.38, 95% CI 1.63–7.03). Conclusions: Monitoring and management of IWS and delirium are highly variable among European PICUs. The use of an analgosedation protocol was associated with an increased likelihood of monitoring IWS and delirium, performing a structured analgosedation weaning and promoting mobilization. Education on this topic and interprofessional collaborations are highly needed to help reduce the burden of analgosedation-associated adverse outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85163092088&partnerID=8YFLogxK
U2 - 10.1002/phar.2831
DO - 10.1002/phar.2831
M3 - Article
C2 - 37203273
AN - SCOPUS:85163092088
SN - 0277-0008
VL - 43
SP - 804
EP - 815
JO - Pharmacotherapy
JF - Pharmacotherapy
IS - 8
ER -