Survey of Sedation and Analgesia Practice Among Canadian Pediatric Critical Care Physicians*

Guerra, Gonzalo Garcia; Joffe, Ari R.; Cave, Dominic; Duff, Jonathan P.; Duncan, Shannon; Sheppard, Cathy; Tawfik, Gerda; Hartling, Lisa; Jou, Hsing; Vohra, Sunita

doi:10.1097/pcc.0000000000000864

Cited by 36 publications

(33 citation statements)

References 35 publications

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“…The latest clinical practice guidelines on analgesia and sedation for critically ill children was published in 2006 . Some surveys demonstrated a large diversity in pain and agitation management in PICUs, even in the same country . A survey in Japanese PICUs was performed in 2012 .…”

Section: Discussionmentioning

confidence: 99%

“…A previous survey in 2012 reported that four out of 17 (24%) PICUs in Japan used sedation scales . In contrast, Canadian pediatric critical care physician‐based studies in 2015 reported that 84% of respondents used pain and sedation scales . Another international, physician‐based survey in 2012 reported that 70% of respondents used sedation scales .…”

Section: Discussionmentioning

confidence: 99%

“…failed to show a beneficial effect of protocolized sedation with daily sedation interruption versus usual care on the length of mechanical ventilation in a large multicenter cluster randomized study . In Canadian studies, analgesia and sedation protocols were used by 36% of respondents . In another international survey, sedation protocols were used by 27% of respondents .…”

Section: Discussionmentioning

confidence: 99%

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Survey of analgesia and sedation in pediatric intensive care units in Japan

Koizumi¹,

Kurosawa

2020

Pediatrics International

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Background: High-quality evidence of analgesia and sedation management in pediatric intensive care units (PICUs) is lacking. Methods: An online survey concerning the institutional management of pain, sedation, delirium, and withdrawal syndrome, as well as non-pharmacological interventions to reduce pain and / or to provide comfort, was conducted with the medical directors of 31 PICUs in Japan. The survey was conducted from September to November 2016. Results: The response rate was 77% (24/31). Pain was routinely assessed in nine (38%) PICUs. Self-report pain scales were used in 14 (58%) PICUs. Observational pain scales for children who were unable to self-report were used in only one PICU. Physician-driven analgesia protocols were used in two (8%) PICUs. Although sedation scales for intubated patients were used in 15 (63%) PICUs, they were used for the goal-directed sedation management in nine (38%). Nurse-driven sedation protocols were used in two (8%) PICUs. Five (21%) PICUs used delirium assessment tools, and delirium screening was not routinely done in any PICU. Five (21%) PICUs regularly used withdrawal assessment tools for a high-risk group of patients with withdrawal syndrome. Non-pharmacological interventions for analgesia and comfort were frequently practiced for mechanically ventilated patients.Conclusions: This study is the first survey conducted by physicians regarding pain and agitation management in PICUs in Japan, and the results revealed great diversity in practice. The implementation strategies to assess pain, delirium, and withdrawal syndrome, as well as to set goals regarding sedation level, are lacking. Protocols for analgesia and sedation management are uncommon.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Survey of analgesia and sedation in pediatric intensive care units in Japan

Koizumi¹,

Kurosawa

2020

Pediatrics International

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“…With all the recent interest and research related to dexmedetomidine, it is becoming more and more common in the ICU. Dexmedetomidine has become a frequent choice for second- or third-line therapy and use is increasing [ 3 ]. The most commonly stated reason for not using dexmedetomidine is its cost, but the decrease in length of stay and dose required may start to mitigate the difference in cost.…”

Section: Reviewmentioning

confidence: 99%

“…Appropriate sedation and use of sedative medications is extremely important in pediatric burn patient due to the pain, anxiety, fear of strangers, separation from parents, and loss of control that can accompany burn injury [ 1 – 3 ]. Additional anxiety related to hospitalization, social situation, and long-term body image compound the problem [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Considerations for pediatric burn sedation and analgesia

Fagin

Palmieri

2017

Burns &Amp; Trauma

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Burn patients experience anxiety and pain in the course of their injury, treatment, and recovery. Hence, treatment of anxiety and pain is paramount after burn injury. Children, in particular, pose challenges in anxiety and pain management due to their unique physiologic, psychologic, and anatomic status. Burn injuries further complicate pain management and sedation as such injuries can have effects on medication response and elimination. Burn injuries further complicate pain management and sedation as such injuries can have effects on medication response and elimination. The purpose of this review is to describe the challenges associated with management of anxiety, pain, and sedation in burned children and to describe the different options for treatment of anxiety and pain in burned children.

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

et al. 2023

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IntroductionAnalgesia 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.MethodsWe 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.ResultsAmong 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).ConclusionsMonitoring 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.

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Survey of Sedation and Analgesia Practice Among Canadian Pediatric Critical Care Physicians*

Cited by 36 publications

References 35 publications

Survey of analgesia and sedation in pediatric intensive care units in Japan

Survey of analgesia and sedation in pediatric intensive care units in Japan

Considerations for pediatric burn sedation and analgesia

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

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