Survey of critical care pharmacists on sedation and analgesia practices in adult and pediatric patients receiving continuous neuromuscular blocking agents

Abstract

AbstractIntroductionThere is a lack of recommendations regarding sedation/analgesia practices for patients receiving continuous or frequent boluses of neuromuscular blocking agents (NMBAs), which may cause variation among different clinical practice sites.ObjectivesThe primary objective of this study was to determine critical care pharmacist's perceptions and practices regarding sedation/analgesia for patients receiving NMBAs and to compare sedation/analgesia regimens among adult and pediatric populations.MethodsA 10‐question survey was provided to critical care pharmacists regarding practice site, comfort using NMBAs, and monitoring practices. Respondents could select all sedation/analgesia regimens they commonly see, would recommend, and would consider inappropriate. Responses from adult and pediatric pharmacists were compared.ResultsOf the 2435 pharmacists who received the survey, 192 (7.9%) completed the survey. Most respondents practiced in the United States (97.9%), cared for adult patients (60.7%), and worked in a medical intensive care unit (ICU) (81.3%). Most respondents reported monitoring sedation depth (82.6%) with vitals (49%) and bispectral index (30.3%) being the most common methods. The most commonly observed regimens were continuous infusion (CI) benzodiazepine and CI opioid (n = 114, 66.7%), followed by propofol and CI opioid (n = 104, 60.8%). These were also the most commonly recommended regimens (n = 102, 59.6%; n = 108, 63.2%), respectively. Most respondents would not recommend monotherapy regimens. Dexmedatomidine was utilized and recommended significantly more by pediatric pharmacists while propofol was utilzied and recommended more by adult pharmaicsts. Regimens deemed inappropriate were similar between adult and pediatric pharmacists except for dexmedetomidine‐containing regimens which significantly more adult pharmacists deemed inappropriate.ConclusionDespite a lack of guideline recommendations, use of combination therapy with sedation/analgesia was frequently reported; however, the choice of sedation agent was variable. Given concern with the inability to achieve deep sedation with dexmedetomidine and a high response rate recommending/utilizing dexmedetomidine, further research is needed to guide recommendations for providing appropriate sedation/analgesia to patients receiving NMBAs.