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. 2022 Mar 31;26(1):88.
doi: 10.1186/s13054-022-03957-7.

Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey

Marco Daverio #  1 , Florian von Borell #  2   3 , Anne-Sylvie Ramelet  4   5 , Francesca Sperotto  1   6 , Paula Pokorna  7   8   9   10 , Sebastian Brenner  3 , Maria Cristina Mondardini  11   12 , Dick Tibboel  13 , Angela Amigoni #  1 , Erwin Ista #  13 ; Analgosedation CONSORTIUM on behalf of the Pharmacology Section and the Nurse Science Section of the European Society of Paediatric and Neonatal Intensive Care
Collaborators, Affiliations

Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey

Marco Daverio et al. Crit Care. .

Erratum in

Abstract

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.

Keywords: Analgesia; Critical care; Monitoring; Pediatric intensive care unit; Sedation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Map describing the distribution of survey responders across European countries. The number of PICUs who replied to the survey (numerator) is reported along with the number of PICUs in each country (denominator) and the percentage of responders. In red countries with a response rate < 33%, in orange 33–66% and green > 66%
Fig. 2
Fig. 2
A–G Analgesia and sedation assessment and monitoring with comparison of PICUs according to their yearly admission volume. CBS COMFORT Behavioral Scale, EDIN Échelle Douleur Inconfort Nouveau-Né, FLACC Faces, Legs, Activity, Cry and Consolability, MAPS Multidimensional Assessment Pain Scale, NIPS Neonatal Infant Pain Scale, SBS State Behavioral Scale, VAS Visual Analogic Scale
See this image and copyright information in PMC

References

    1. Aranda JV. Neonatal and pediatric pharmacology: therapeutic principles in practice. 5. Philadelphia: Lippincott Williams & Wilkins (LWW); 2020.
    1. Egbuta C, Mason KP. Current state of analgesia and sedation in the pediatric intensive care unit. J Clin Med. 2021 doi: 10.3390/jcm10091847. - DOI - PMC - PubMed
    1. Ista E, Van Dijk M, Gamel C, Tibboel D, De Hoog M. Withdrawal symptoms in critically ill children after long-term administration of sedatives and/or analgesics: a first evaluation. Crit Care Med. 2008;36(8):2427–2432. doi: 10.1097/CCM.0b013e318181600d. - DOI - PubMed
    1. Choong K. Picu-acquired complications: the new marker of the quality of care. ICU Manag Pract. 2019;19(2):85–88.
    1. Association of Paediatric Anaesthetists of Great Britain and Ireland. Good Practice in Postoperative and Procedural Pain Management 2nd Edition. Pediatr Anesth. 2012. 10.1111/j.1460-9592.2012.3838.x. - PubMed

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