Survey on monitoring analgesia and sedation in the Italian Pediatric Intensive Care Units

Abstract

Background: Admission in Pediatric Intensive Care Unit requires management and monitoring of analgesia and sedation, in order to reduce their adverse effects, and to prevent withdrawal syndrome and delirium. The aim of this study was to evaluate the management of analgesia and sedation in critically ill children admitted in the Italian Pediatric Intensive Care Units.

Methods: For this survey we have submitted a telematics questionnaire to 24 nursing coordinators of the Pediatric Intensive Care Units or Neonatal Intensive Care Units admitting critically ill children.

Results: Twenty Intensive Care Units (ICUs) replied to the questionnaire. The association of benzodiazepines and opioids was the first choice in 92.8% of analgesic and sedative strategies. Seventy percent of ICUs adopted a protocol for analgesic and sedative drugs used before performing invasive and/or painful procedures in critically ill children. Ninety percent of them followed a protocol for the assessment of pain, 75% adopting the Face, Legs, Activity, Cry, Consolability Scale. Sixty percent of ICUs followed a protocol for sedation, 58% used the Comfort Scale to monitor the level of it. Forty percent adopted a protocol for the withdrawal syndrome, 75% of them monitored the patients with the WAT-1 Scale. Ten percent of Pediatric Intensive Care Units followed a protocol for management of delirium; seventy-five percent did not monitor it.

Conclusions: Despite an increasing sensitivity in pain and sedation management over the last five years, knowledge and monitoring of abstinence syndrome and delirium need to be improved.