TY - JOUR
T1 - Sedation, sleep promotion, and delirium screening practices in the care of mechanically ventilated children
T2 - A wake-up call for the pediatric critical care community
AU - Kudchadkar, Sapna R.
AU - Yaster, Myron
AU - Punjabi, Naresh M.
PY - 2014/7
Y1 - 2014/7
N2 - OBJECTIVES: To examine pediatric intensivist sedation management, sleep promotion, and delirium screening practices for intubated and mechanically ventilated children. DESIGN:: An international, online survey of questions regarding sedative and analgesic medication choices and availability, sedation protocols, sleep optimization, and delirium recognition and treatment. SETTING:: Member societies of the World Federation of Pediatric Intensive and Critical Care Societies were asked to send the survey to their mailing lists; responses were collected from July 2012 to January 2013. SUBJECTS:: Pediatric critical care providers. INTERVENTIONS:: Survey. MEASUREMENTS AND MAIN RESULTS:: The survey was completed by 341 respondents, the majority of whom were from North America (70%). Twenty-seven percent of respondents reported having written sedation protocols. Most respondents worked in PICUs with sedation scoring systems (70%), although only 42% of those with access to scoring systems reported routine daily use for goal-directed sedation management. The State Behavioral Scale was the most commonly used scoring system in North America (22%), with the COMFORT score more prevalent in all other countries (39%). The most commonly used sedation regimen for intubated children was a combination of opioid and benzodiazepine (72%). Most intensivists chose fentanyl as their first-line opioid (66%) and midazolam as their first-line benzodiazepine (86%) and prefer to administer these medications as continuous infusions. Propofol and dexmedetomidine were the most commonly restricted medications in PICUs internationally. Use of earplugs, eye masks, noise reduction, and lighting optimization for sleep promotion was uncommon. Delirium screening was not practiced in 71% of respondent's PICUs, and only 2% reported routine screening at least twice a day. CONCLUSIONS:: The results highlight the heterogeneity in sedation practices among intensivists who care for critically ill children as well as a paucity of sleep promotion and delirium screening in PICUs worldwide.
AB - OBJECTIVES: To examine pediatric intensivist sedation management, sleep promotion, and delirium screening practices for intubated and mechanically ventilated children. DESIGN:: An international, online survey of questions regarding sedative and analgesic medication choices and availability, sedation protocols, sleep optimization, and delirium recognition and treatment. SETTING:: Member societies of the World Federation of Pediatric Intensive and Critical Care Societies were asked to send the survey to their mailing lists; responses were collected from July 2012 to January 2013. SUBJECTS:: Pediatric critical care providers. INTERVENTIONS:: Survey. MEASUREMENTS AND MAIN RESULTS:: The survey was completed by 341 respondents, the majority of whom were from North America (70%). Twenty-seven percent of respondents reported having written sedation protocols. Most respondents worked in PICUs with sedation scoring systems (70%), although only 42% of those with access to scoring systems reported routine daily use for goal-directed sedation management. The State Behavioral Scale was the most commonly used scoring system in North America (22%), with the COMFORT score more prevalent in all other countries (39%). The most commonly used sedation regimen for intubated children was a combination of opioid and benzodiazepine (72%). Most intensivists chose fentanyl as their first-line opioid (66%) and midazolam as their first-line benzodiazepine (86%) and prefer to administer these medications as continuous infusions. Propofol and dexmedetomidine were the most commonly restricted medications in PICUs internationally. Use of earplugs, eye masks, noise reduction, and lighting optimization for sleep promotion was uncommon. Delirium screening was not practiced in 71% of respondent's PICUs, and only 2% reported routine screening at least twice a day. CONCLUSIONS:: The results highlight the heterogeneity in sedation practices among intensivists who care for critically ill children as well as a paucity of sleep promotion and delirium screening in PICUs worldwide.
KW - analgesia
KW - circadian rhythm
KW - delirium
KW - intensive care units
KW - mechanical ventilation
KW - pediatric
KW - sedation
KW - sleep
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U2 - 10.1097/CCM.0000000000000326
DO - 10.1097/CCM.0000000000000326
M3 - Article
C2 - 24717461
AN - SCOPUS:84902549446
SN - 0090-3493
VL - 42
SP - 1592
EP - 1600
JO - Critical care medicine
JF - Critical care medicine
IS - 7
ER -