A survey of sedation assessment and management in Australian and New Zealand paediatric intensive care patients requiring prolonged mechanical ventilation.
BACKGROUND
A retrospective analysis of sedation management for children receiving prolonged ventilation in one Australian paediatric intensive care unit (PICU) revealed no identifiable pattern in sedation management and an inadequacy in the sedation scoring system. Therefore, the investigators sought to explore the current practice of sedation in critically ill children in PICUs across Australia and New Zealand.


METHODS
This study used a mail-out survey to audit sedation management within the eight dedicated Australian and New Zealand PICUs.


RESULTS
100% of the units surveyed replied (n=8). There were a total of 6,133 admissions to 8 Australian and New Zealand PICUs, where 3036 (49.5%) required ventilation. Of these children, 888 (29.2%) required ventilation > or =72 hours. Only 4 units had written guidelines for sedation management. A combined sedation regime of benzodiazepines and opioids was employed in six units. Administration and titration of sedation agents was managed by nursing staff alone in six units. All units indicated that they aimed to achieve a 'moderate level' of sedation. Two units used designated assessment tools for sedation and withdrawal assessment. One unit utilised Bispectral Index (BIS) monitoring.


CONCLUSIONS
There were similarities observed in the methods and types of sedation agents used within Australian and New Zealand PICUs. However, only half of the units had guidelines for sedation management, and most units did not use validated paediatric scales to assist staff in assessing patient sedation and pain levels. Therefore it is recommended that a standardised approach to sedation assessment and management of critically ill children requiring prolonged ventilation be developed and tested.
Royal Children's Hospital, Brisbane, QLD.
Debbie
D
Long
Desley
D
Horn
Samantha
S
Keogh
D001315:Australia; D002648:Child; D016292:Procedural Sedation / Q000379:methods / Q000451:nursing* / Q000592:standards; D003422:Critical Care / Q000458:organization & administration*; D016903:Drug Monitoring / Q000379:methods / Q000451:nursing* / Q000592:standards; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous / Q000451:nursing; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration; D009520:New Zealand; D009730:Nursing Assessment / Q000458:organization & administration*; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D010147:Pain Measurement / Q000379:methods / Q000451:nursing; D010343:Patient Admission; D010371:Pediatric Nursing / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000379:methods / Q000451:nursing* / Q000592:standards; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors