Sedation and analgesia for critically ill pediatric burn patients: the current state of practice.
The objective of this study was to assess current practice patterns and attitudes toward pediatric sedation and analgesia in United States (US) burn centers for critically ill patients. Survey-based questionnaire was sent to 119 Directors at US burn centers that care for pediatric patients. Forty-one surveys (34%) were analyzed. 48.8% of responding centers mandate pediatric consultation for pediatric burn patients based on factors such as age and burn size. The most common sedation and analgesic agents used were midazolam, fentanyl, morphine, ketamine, and diphenhydramine. Written sedation policies exist at 63.4% of centers. 90.2% of centers employ scoring systems to guide agent titration. 60.9% of respondents practice sedation holidays "always" or "usually." 90.2% of centers perceive the medications they routinely use are "always" or "often" efficacious in pediatric sedation and analgesia. 53.7% of respondents reported the presence of withdrawal signs and symptoms in their patient population. The lack of consensus guidelines for sedation and analgesia delivery to pediatric intensive care unit patients results in practice variation. The majority of centers perceive their sedation and analgesia strategies to be efficacious despite the heavy reliance on propofol and midazolam, both of which have questionable safety profiles in critically ill children.
From the *Department of Surgery, 30 N Medical Drive, University of Utah, Salt Lake City, Utah 84132.
Andrew
A
Singleton
Robert J
RJ
Preston
Amalia
A
Cochran
D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use*; D002056:Burns / Q000188:drug therapy* / Q000628:therapy; D002648:Child; D016638:Critical Illness; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D010147:Pain Measurement / Q000379:methods; D014481:United States / Q000453:epidemiology
D000700:Analgesics; D006993:Hypnotics and Sedatives