Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey.
Details
Serval ID
serval:BIB_0BDDF8C6D8CE
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey.
Journal
Critical care
Working group(s)
Analgosedation CONSORTIUM on behalf of the Pharmacology Section and the Nurse Science Section of the European Society of Paediatric and Neonatal Intensive Care
Contributor(s)
Kola E., Vittinghoff M., Duval E., Polić B., Valla F., Neunhoeffer F., Konstantinos T., Györgyi Z., Tan M.H., Hasani A., Poluzioroviene E., Balmaks R., Afanetti M., Bentsen G., Bartkowska-Sniatkowska A., Camilo C., Simic D., López-Fernández Y.M., Mattsson J., Özen H., Dmytriiev D., Manning J.C., Tekgüç H.
ISSN
1466-609X (Electronic)
ISSN-L
1364-8535
Publication state
Published
Issued date
31/03/2022
Peer-reviewed
Oui
Volume
26
Number
1
Pages
88
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Abstract
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.
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.
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.
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.
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.
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.
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.
Keywords
Analgesia/methods, Child, Europe, Humans, Intensive Care Units, Pediatric, Pain, Surveys and Questionnaires, Analgesia, Critical care, Monitoring, Pediatric intensive care unit, Sedation
Pubmed
Web of science
Open Access
Yes
Create date
11/04/2022 9:13
Last modification date
23/01/2024 8:20
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