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

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.

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

“…Following publication of the original article [ 1 ], the authors identified an error in the author name Marco Daverio. The given name and family name were erroneously transposed.…”

Assessment and management of iatrogenic withdrawal syndrome and delirium in pediatric intensive care units across Europe: An ESPNIC survey

“…The survey included single‐ and multiple‐choice closed‐ended questions to facilitate analyses and comparisons, as well as free‐text questions to allow the extrapolation of more detailed information. The first part of the survey was dedicated to define the analgesia and sedation practices in Europe and was previously published 15 . The second part of the survey is presented here and consisted of 11 overlapping questions with the first survey on PICU characteristics, and another 32 questions organized within the following sections: Section 1: practices related to the analgosedation weaning and IWS prevention; Section 2 : diagnosis and management of IWS and delirium; and Section 3 : practices related to early mobilization (Appendix S1).…”

Maternal voice reduces procedural pain in neonates: A meta-analysis of randomized controlled trials

“…Many repeated pain stimuli will cause stress reactions to the body, leading to a series of short-term and long-term adverse effects on neonates. [ 6 – 8 ]…”