Current United Kingdom sedation practice in pediatric intensive care.
BACKGROUND
The aim of this study was to investigate the current practice of sedation, analgesia, and neuromuscular blockade in critically ill children on pediatric intensive care units (PICUs) in the UK and identify areas that merit further study.


METHODS
Data were gathered in a prospective observational study of 338 critically ill children in 20 UK PICUs.


RESULTS
There is considerable variation in clinical practice. A total of 24 different sedative and analgesic agents were used during the study. The most commonly used sedative and analgesic agents were midazolam and morphine. Four different neuromuscular blockers (NMBs) were used, most commonly vecuronium. There were differences in treatment between cardiac and noncardiac children, but there were a greater number of infants and neonates in the cardiac group. NMBs were used in 30% of mechanically ventilated patients. Withdrawal symptoms were reported in 13% of ventilated patients, relatively early in their stay; weaning sedative agents ('tapering') was apparently of no benefit. The use of clonidine in this setting was noted. Physical restraints were used in 7.4%. Propofol was used but in only 2.6% of patients, all over the age of 4 years, and not exceeding 2 mgxkg(-1)xh(-1). No side effects attributable to 'propofol syndrome' were noted.


CONCLUSIONS
There is considerable heterogeneity of sedation techniques. NMBs are used in a large portion of this population. Withdrawal symptoms were associated with higher doses of sedation and greater lengths of stay and were not ameliorated by withdrawing sedation gradually ('tapering').
Jenkins
Ian A
IA
Paediatric Intensive Care Society Study Group, UK. ian.jenkins@ubht.nhs.uk
Playfor
Stephen D
SD
Bevan
Cliff
C
Davies
Gerald
G
Wolf
Andrew R
AR
D000293:Adolescent; D000700:Analgesics; D000701:Analgesics, Opioid; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D003422:Critical Care; D004363:Drug Utilization; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006993:Hypnotics and Sedatives; D007223:Infant; D007231:Infant, Newborn; D007275:Injections, Intravenous; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D008874:Midazolam; D009020:Morphine; D011446:Prospective Studies; D012121:Respiration, Artificial; D013514:Surgical Procedures, Operative; D006113:United Kingdom
D000700:Analgesics; D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009020:Morphine; D008874:Midazolam