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Sedation and Analgesia Practices in Pediatric Intensive Care Units: A Survey of 27 Centers from Turkey

Faruk Ekinci1, Dincer Yildizdas1, Ozden Ozgur Horoz1

  • 1Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey.

Journal of Pediatric Intensive Care
|November 8, 2021
PubMed

Insights

Effective pediatric intensive care unit (PICU) sedation and analgesia management is crucial. This study surveyed Turkish PICUs, revealing a need for standardized, evidence-based protocols for sedation, analgesia, withdrawal, and delirium.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Intensive Care Nursing

Background:

  • Sedoanalgesia management in Pediatric Intensive Care Units (PICUs) is vital for procedural efficacy, mechanical ventilation support, and preventing adverse events like withdrawal syndrome and delirium.
  • Current practices in sedation, analgesia, withdrawal, and delirium (SAD) management in PICUs require further clarification to optimize patient outcomes.
  • A need exists to analyze and standardize SAD approaches within Turkish PICUs.

Purpose of the Study:

  • To investigate and analyze current sedation, analgesia, withdrawal, and delirium practices in Turkish PICUs.
  • To identify variations and commonalities in SAD management strategies across different PICUs.
  • To provide insights for developing standardized, evidence-based algorithms for pediatric sedoanalgesia.

Main Methods:

  • A survey was distributed to 27 PICUs across Turkey to gather data on their SAD management protocols and practices.
  • Data collected included information on written protocols, preferred agents for different procedures (postoperative, short-term interventions, prolonged sedation), and second-line agent choices.
  • Descriptive statistics were used to analyze the survey responses.

Main Results:

  • Only 33.3% and 48.1% of surveyed PICUs had written protocols for analgesia and sedation, respectively.
  • Paracetamol and midazolam/fentanyl combinations were common for postoperative care (51.8% and 40%). Ketamine was preferred for short-term interventions (81.4%).
  • For prolonged sedation in ventilated children, benzodiazepines/opiates were first-line (81.4%), with ketamine and dexmedetomidine as second-line options (62.9% and 18.5%).

Conclusions:

  • Turkish PICU practices for sedative and analgesic agent selection show some alignment with existing literature.
  • A significant gap exists in the implementation of written protocols for analgesia and sedation management.
  • There is a clear and urgent need to develop and implement a standardized, evidence-based algorithm for sedation and analgesia in pediatric intensive care settings.

Keywords:
analgesiadeliriumpediatric intensive caresedationwithdrawal

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