Sedation, analgesia, and neuromuscular blockade in the pediatric intensive care unit: survey of fellowship training programs.
OBJECTIVE
To survey current sedation, analgesia, and neuromuscular blockade practices in pediatric critical care fellowship training programs in the United States.


METHODS
Questionnaire survey sent by all program directors. The survey could be submitted either via a Web site, fax, or mail.


METHODS
University school of medicine.


METHODS
Fifty-nine pediatric critical care fellowship training program directors in the United States, listed on the Accreditation Council for Graduate Medical Education Web site.


METHODS
Survey.


RESULTS
The response rate was 59.3% (35 questionnaires). Midazolam, lorazepam, morphine, and fentanyl are the most frequently used drugs in pediatric intensive care units for analgesia and sedation. Most pediatric intensive care units surveyed have a written sedation policy (66%). The majority of units responding to the survey (85.7%) routinely use a scoring system to assess agitation and pain in children, with the most common being the COMFORT score. All of the pediatric intensive care units surveyed reported weaning drugs slowly to try to prevent drug withdrawal. Movement disorders related to prolonged sedation and analgesia seem to be more common than is reported in the literature, with 65.7% of units reporting cases. There is good consensus on the indications for neuromuscular blockade, with vecuronium being the most popular drug.


CONCLUSIONS
When compared with a similar survey from 1989, this survey suggests that pediatric critical care units with fellowship training programs have made some changes in their approach to sedation and analgesia over the past decade. More fellowship directors report the use of sedation protocols and better recognition, prevention, and management of drug withdrawal. Similar analgesic, sedative, and neuromuscular blocking drugs are being used but some more commonly than a decade ago.
Twite
Mark D
MD
Pediatrics (Critical Care) and Anesthesiology, The Children's Hospital, Denver, CO, USA.
Rashid
Asrar
A
Zuk
Jeannie
J
Friesen
Robert H
RH
D000700:Analgesics; D002648:Child; D004363:Drug Utilization; D006801:Humans; D006993:Hypnotics and Sedatives; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007396:Internship and Residency; D009466:Neuromuscular Blocking Agents; D010147:Pain Measurement / Q000379:methods; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
D000700:Analgesics; D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents