Practices related to assessment of sedation, analgesia and delirium among critical care pediatricians in Brazil.

José Colleti,Orlei Ribeiro De Araujo,Alice Barone De Andrade,Werther Brunow De Carvalho

doi:10.31744/einstein_journal/2020ao5168

José Colleti, Orlei Ribeiro De Araujo + Show 2 more

Open Access

https://doi.org/10.31744/einstein_journal/2020ao5168

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Abstract

ABSTRACTObjective To understand the use of tools, protocols and comfort measures related to sedation/analgesia, and to screen the occurrence of delirium in pediatric intensive care units.Methods A survey with 14 questions was distributed by e-mail to Brazilian critical care pediatricians. Eight questions addressed physician and hospital demographics, and six inquired practices to assess sedation, analgesia, and delirium in pediatric intensive care units.Results Of 373 questionnaires sent, 61 were answered (16.3%). The majority of physicians were practicing in the Southeast region (57.2%). Of these, 46.5% worked at public hospitals, 28.6% of which under direct state administration. Of respondents, 57.1% used formal protocols for sedation and analgesia, and the Ramsay scale was the most frequently employed (52.5%). Delirium screening scores were not used by 48.2% of physicians. The Cornell Assessment of Pediatric Delirium was the score most often used (23.2%). The majority (85.7%) of physicians did not practice daily sedation interruption, and only 23.2% used non-pharmacological measures for patient comfort frequently, with varied participation of parents in the process.Conclusion This study highlights the heterogeneity of practices for assessment of sedation/analgesia and lack of detection of delirium among critical care pediatricians in Brazil.

Highlights

Sedation and analgesia are important and necessary components of care for the majority of patients admitted to a pediatric intensive care unit (PICU), patients requiring mechanical ventilation (MV).(1,2) Major indications include control of pain, anxiety and agitation; induction of amnesia; facilitation of MV; prevention of endotracheal dislodgement; and reduction of cell metabolism.[1,2]The adverse impact of inefficient sedation and analgesia practices at the PICU has become the focus of attention for researchers and clinicians, alongside concerns generated by the use of too light or too deep sedation levels.[3]
Both inadequately light and excessively deep sedation have the potential to produce safety problems for patients, and effects on the duration of MV, on hospital length of stay and costs.[3]. Consequences of prolonged use of sedative and analgesic drugs at the PICU include changes in the central nervous system, gastrointestinal disturbances and sympathetic hyperactivity
Our assumption was of the occurrence of high variability in sedation and analgesia approaches for the critically ill child admitted to the PICU, and that sleep promotion and detection of delirium are not routinely implemented

Summary

Introduction

Sedation and analgesia are important and necessary components of care for the majority of patients admitted to a pediatric intensive care unit (PICU), patients requiring mechanical ventilation (MV).(1,2) Major indications include control of pain, anxiety and agitation; induction of amnesia; facilitation of MV (reduction of asynchrony); prevention of endotracheal dislodgement; and reduction of cell metabolism.[1,2]The adverse impact of inefficient sedation and analgesia practices at the PICU has become the focus of attention for researchers and clinicians, alongside concerns generated by the use of too light or too deep sedation levels.[3]. Sedation and analgesia are important and necessary components of care for the majority of patients admitted to a pediatric intensive care unit (PICU), patients requiring mechanical ventilation (MV).(1,2) Major indications include control of pain, anxiety and agitation; induction of amnesia; facilitation of MV (reduction of asynchrony); prevention of endotracheal dislodgement; and reduction of cell metabolism.[1,2]. Our assumption was of the occurrence of high variability in sedation and analgesia approaches for the critically ill child admitted to the PICU, and that sleep promotion and detection of delirium are not routinely implemented The most commonly used medications (opioids and benzodiazepines) can cause hemodynamic and respiratory instability, prolonged MV, abstinence symptoms, delirium, nosocomial infection and critical illness neuromyopathy.[1,4]

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