title: Survey of Sedation and Analgesia Practice Among Canadian Pediatric Critical Care Physicians.
abstract: Despite the fact that almost all critically ill children experience some degree of pain or anxiety, there is a lack of high-quality evidence to inform preferred approaches to sedation, analgesia, and comfort measures in this environment. We conducted this survey to better understand current comfort and sedation practices among Canadian pediatric intensivists.
  
  
  
  The survey was conducted after a literature review and initial focus groups. The survey was then pretested and validated. The final survey was distributed by email to 134 intensivists from 17 PICUs across Canada using the Research Electronic Data Capture system.
  
  
  
  The response rate was 73% (98/134). The most commonly used sedation scores are Face, Legs, Activity, Cry, and Consolability (42%) and COMFORT (41%). Withdrawal scores are commonly used (65%). In contrast, delirium scores are used by only 16% of the respondents. Only 36% of respondents have routinely used sedation protocols. The majority (66%) do not use noise reduction methods, whereas only 23% of respondents have a protocol to promote day/night cycles. Comfort measures including music, swaddling, soother, television, and sucrose solutions are frequently used. The drugs most commonly used to provide analgesia are morphine and acetaminophen. Midazolam and chloral hydrate were the most frequent sedatives.
  
  
  
  Our survey demonstrates great variation in practice in the management of pain and anxiety in Canadian PICUs. Standardized strategies for sedation, delirium and withdrawal, and sleep promotion are lacking. There is a need for research in this field and the development of evidence-based, pediatric sedation and analgesia guidelines.
authors.affiliation: 1Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. 2Stollery Children's Hospital, Edmonton, AB, Canada. 3Pharmacy Services, Alberta Health Services - Edmonton and Area, Edmonton, AB, Canada. 4Integrative Health Institute, University of Alberta, Edmonton, AB, Canada.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Garcia Guerra
authors.forename: Ari R
authors.initials: AR
authors.lastname: Joffe
authors.forename: Dominic
authors.initials: D
authors.lastname: Cave
authors.forename: Jonathan
authors.initials: J
authors.lastname: Duff
authors.forename: Shannon
authors.initials: S
authors.lastname: Duncan
authors.forename: Cathy
authors.initials: C
authors.lastname: Sheppard
authors.forename: Gerda
authors.initials: G
authors.lastname: Tawfik
authors.forename: Lisa
authors.initials: L
authors.lastname: Hartling
authors.forename: Hsing
authors.initials: H
authors.lastname: Jou
authors.forename: Sunita
authors.initials: S
authors.lastname: Vohra
mesh_terms: D000698:Analgesia / Q000379:methods* / Q000706:statistics & numerical data; D002170:Canada; D002648:Child; D002985:Clinical Protocols; D016292:Procedural Sedation / Q000379:methods* / Q000706:statistics & numerical data; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*