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 an...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-03-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-022-03957-7 |
| _version_ | 1819052408870797312 |
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| author | Daverio Marco Florian von Borell Anne-Sylvie Ramelet Francesca Sperotto Paula Pokorna Sebastian Brenner Maria Cristina Mondardini Dick Tibboel Angela Amigoni Erwin Ista the Analgosedation CONSORTIUM on behalf of the Pharmacology Section and the Nurse Science Section of the European Society of Paediatric and Neonatal Intensive Care |
| author_facet | Daverio Marco Florian von Borell Anne-Sylvie Ramelet Francesca Sperotto Paula Pokorna Sebastian Brenner Maria Cristina Mondardini Dick Tibboel Angela Amigoni Erwin Ista the Analgosedation CONSORTIUM on behalf of the Pharmacology Section and the Nurse Science Section of the European Society of Paediatric and Neonatal Intensive Care |
| author_sort | Daverio Marco |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-21T12:19:22Z |
| format | Article |
| id | doaj.art-66d800d113ca4a4b8bd7651dfddcf6b7 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-21T12:19:22Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-66d800d113ca4a4b8bd7651dfddcf6b72022-12-21T19:04:21ZengBMCCritical Care1364-85352022-03-0126111310.1186/s13054-022-03957-7Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC surveyDaverio Marco0Florian von Borell1Anne-Sylvie Ramelet2Francesca Sperotto3Paula Pokorna4Sebastian Brenner5Maria Cristina Mondardini6Dick Tibboel7Angela Amigoni8Erwin Ista9the Analgosedation CONSORTIUM on behalf of the Pharmacology Section and the Nurse Science Section of the European Society of Paediatric and Neonatal Intensive CarePediatric Intensive Care Unit, Department of Woman’s and Child’s Health, University Hospital of PaduaDepartment of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical SchoolInstitute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of LausannePediatric Intensive Care Unit, Department of Woman’s and Child’s Health, University Hospital of PaduaInstitute of Pharmacology, First Faculty of Medicine, Charles University and General University HospitalDepartment of Pediatric and Adolescent Medicine, University Clinic Carl Gustav CarusPediatric Anesthesia and Intensive Care Unit, Department of Woman’s and Child’s Health, IRCCS University Hospital of Bologna Policlinico S.OrsolaPediatric Intensive Care Unit, Department of Pediatric Surgery, • Erasmus MC – Sophia Children’s Hospital, University Medical Center RotterdamPediatric Intensive Care Unit, Department of Woman’s and Child’s Health, University Hospital of PaduaPediatric Intensive Care Unit, Department of Pediatric Surgery, • Erasmus MC – Sophia Children’s Hospital, University Medical Center RotterdamAbstract 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.https://doi.org/10.1186/s13054-022-03957-7AnalgesiaSedationCritical carePediatric intensive care unitMonitoring |
| spellingShingle | Daverio Marco Florian von Borell Anne-Sylvie Ramelet Francesca Sperotto Paula Pokorna Sebastian Brenner Maria Cristina Mondardini Dick Tibboel Angela Amigoni Erwin Ista the Analgosedation CONSORTIUM on behalf of the Pharmacology Section and the Nurse Science Section of the European Society of Paediatric and Neonatal Intensive Care Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey Critical Care Analgesia Sedation Critical care Pediatric intensive care unit Monitoring |
| title | Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey |
| title_full | Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey |
| title_fullStr | Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey |
| title_full_unstemmed | Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey |
| title_short | Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey |
| title_sort | pain and sedation management and monitoring in pediatric intensive care units across europe an espnic survey |
| topic | Analgesia Sedation Critical care Pediatric intensive care unit Monitoring |
| url | https://doi.org/10.1186/s13054-022-03957-7 |
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