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.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.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.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.
