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Current United Kingdom sedation practice in pediatric intensive care
Ian A Jenkins1, Stephen D Playfor, Cliff Bevan
1Paediatric Intensive Care Society Study Group, UK. ian.jenkins@ubht.nhs.uk
Paediatric Anaesthesia
|June 15, 2007
Summary
Pediatric intensive care units (PICUs) show varied sedation and analgesia practices. Neuromuscular blockers (NMBs) are common, and withdrawal symptoms occur frequently, unaffected by gradual sedative weaning.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Clinical Practice Research
Background:
- Critically ill children in UK Pediatric Intensive Care Units (PICUs) require sedation, analgesia, and neuromuscular blockade.
- Understanding current practices is crucial for improving patient care and identifying research gaps.
Purpose of the Study:
- To investigate current sedation, analgesia, and neuromuscular blockade practices in UK PICUs.
- To identify areas for further research in pediatric critical care.
Main Methods:
- Prospective observational study involving 338 critically ill children across 20 UK PICUs.
- Data collection on sedative, analgesic, and neuromuscular blocking agent usage.
Main Results:
- Significant variation in the use of 24 different sedative and analgesic agents, with midazolam and morphine being most common.
- Neuromuscular blockers (NMBs) used in 30% of ventilated patients; vecuronium most frequent.
- Withdrawal symptoms reported in 13% of ventilated patients; gradual sedative weaning ('tapering') showed no benefit. Clonidine use and physical restraints also noted.
Conclusions:
- Heterogeneity in sedation techniques is evident in UK PICUs.
- NMBs are frequently employed in critically ill children.
- Withdrawal symptoms are linked to higher sedation doses and longer hospital stays, and are not prevented by gradual sedative tapering.
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