TY - JOUR
T1 - Pain and sedation management and monitoring in pediatric intensive care units across Europe
T2 - an ESPNIC survey
AU - Marco, Daverio
AU - von Borell, Florian
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 - Ramelet, Anne Sylvie
AU - Sperotto, Francesca
AU - Pokorna, Paula
AU - Brenner, Sebastian
AU - Mondardini, Maria Cristina
AU - Tibboel, Dick
AU - Amigoni, Angela
AU - Ista, Erwin
AU - Kola, Ermira
AU - Vittinghoff, Maria
AU - Duval, Elim
AU - Polić, Branka
AU - Valla, Frédéric
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 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/3/31
Y1 - 2022/3/31
N2 - Background: Management and monitoring of pain and sedation to reduce discomfort as well as side effects, such as over- and under-sedation, withdrawal syndrome and delirium, is an integral part of pediatric intensive care practice. However, the current state of management and monitoring of analgosedation across European pediatric intensive care units (PICUs) remains unknown. The aim of this survey was to describe current practices across European PICUs regarding the management and monitoring of pain and sedation. Methods: An online survey was distributed among 357 European PICUs assessing demographic features, drug choices and dosing, as well as usage of instruments for monitoring pain and sedation. We also compared low- and high-volume PICUs practices. Responses were collected from January to April 2021. Results: A total of 215 (60% response rate) PICUs from 27 European countries responded. Seventy-one percent of PICUs stated to use protocols for analgosedation management, more frequently in high-volume PICUs (77% vs 63%, p = 0.028). First-choice drug combination was an opioid with a benzodiazepine, namely fentanyl (51%) and midazolam (71%) being the preferred drugs. The starting doses differed between PICUs from 0.1 to 5 mcg/kg/h for fentanyl, and 0.01 to 0.5 mg/kg/h for midazolam. Daily assessment and documentation for pain (81%) and sedation (87%) was reported by most of the PICUs, using the preferred validated FLACC scale (54%) and the COMFORT Behavioural scale (48%), respectively. Both analgesia and sedation were mainly monitored by nurses (92% and 84%, respectively). Eighty-six percent of the responding PICUs stated to use neuromuscular blocking agents in some scenarios. Monitoring of paralysed patients was preferably done by observation of vital signs with electronic devices support. Conclusions: This survey provides an overview of current analgosedation practices among European PICUs. Drugs of choice, dosing and assessment strategies were shown to differ widely. Further research and development of evidence-based guidelines for optimal drug dosing and analgosedation assessment are needed.
AB - Background: Management and monitoring of pain and sedation to reduce discomfort as well as side effects, such as over- and under-sedation, withdrawal syndrome and delirium, is an integral part of pediatric intensive care practice. However, the current state of management and monitoring of analgosedation across European pediatric intensive care units (PICUs) remains unknown. The aim of this survey was to describe current practices across European PICUs regarding the management and monitoring of pain and sedation. Methods: An online survey was distributed among 357 European PICUs assessing demographic features, drug choices and dosing, as well as usage of instruments for monitoring pain and sedation. We also compared low- and high-volume PICUs practices. Responses were collected from January to April 2021. Results: A total of 215 (60% response rate) PICUs from 27 European countries responded. Seventy-one percent of PICUs stated to use protocols for analgosedation management, more frequently in high-volume PICUs (77% vs 63%, p = 0.028). First-choice drug combination was an opioid with a benzodiazepine, namely fentanyl (51%) and midazolam (71%) being the preferred drugs. The starting doses differed between PICUs from 0.1 to 5 mcg/kg/h for fentanyl, and 0.01 to 0.5 mg/kg/h for midazolam. Daily assessment and documentation for pain (81%) and sedation (87%) was reported by most of the PICUs, using the preferred validated FLACC scale (54%) and the COMFORT Behavioural scale (48%), respectively. Both analgesia and sedation were mainly monitored by nurses (92% and 84%, respectively). Eighty-six percent of the responding PICUs stated to use neuromuscular blocking agents in some scenarios. Monitoring of paralysed patients was preferably done by observation of vital signs with electronic devices support. Conclusions: This survey provides an overview of current analgosedation practices among European PICUs. Drugs of choice, dosing and assessment strategies were shown to differ widely. Further research and development of evidence-based guidelines for optimal drug dosing and analgosedation assessment are needed.
UR - https://www.scopus.com/pages/publications/85127429497
U2 - 10.1186/s13054-022-03957-7
DO - 10.1186/s13054-022-03957-7
M3 - Article
C2 - 35361254
AN - SCOPUS:85127429497
SN - 1364-8535
VL - 26
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 88
ER -