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P39 Current sedation practice in a paediatric intensive care unit in a UK hospital
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  1. Mohammed Abou Daya1,
  2. Asia Rashed2,
  3. Chloe Benn1,
  4. Lekha Shah1
  1. 1Barts Health NHS Trust
  2. 2King’s College London

Abstract

Aim Sedation is a crucial part of management of patients on paediatric intensive care unit (PICU). The majority of patients admitted to PICU receive sedative agents.1 For example, we estimated that approximately 50% of PICU patients at our trust are sedated at any given time. Heterogeneity in sedation practice can lead to under- or over-sedation of patients and subsequent complications, e.g. increased PICU stay.2 Because of the limited research on sedative agents’ pharmacokinetics and the considerable variability in sedation prescribing practice,3 regular evaluation and review of sedation prescribing practice on PICU is crucial. Thus, the aim of this study was to review the current sedation practice in PICU in a large UK children’s hospital.

Methods A prospective study of patients in a PICU was conducted over a 4-week period. All patients aged ≤18 years admitted to PICU started on continuous IV or enteral sedation were included. Patients on patient-controlled analgesia, started on sedatives at a different hospital, and were transferred still on sedatives or that passed away were excluded. Patient characteristics and any data relevant to the sedative agents prescribed were recorded. Descriptive analysis of the collected data was performed using SPSS software (version 27). Data was presented as frequencies, percentages, median (with interquartile range, IQR) and means (±standard deviation) as appropriate. Nurse Interpreted Score for Sedation (NISS) was used to interpret the level of sedation for each patient. A NISS score of 1 is considered under-sedation, 2 is adequate sedation, and 3 is over-sedation.4

Results In total, 19 patients were included. The most common sedatives prescribed were morphine and midazolam (94.7%, 18/19, each). The median length of PICU stay was 4 days (IQR 3 – 8). Majority of patients on sedatives received 2 to 3 agents (93.2%, 12/19). Trauma patients were on sedation for the longest period with a mean of 25±9 days. All of the sedative doses prescribed were within the recommended ranges by the hospital and national guidelines,2 3 and the cumulative doses were lower than the dosage threshold established for side effects.3 Morphine (7/19), fentanyl (5/19) and enteral clonidine (4/19) were the most common drugs continued over 72 hours. The median NISS score for patients was 2 (IQR 1.3–2.4).

Conclusions Most of the sedation prescribed in the PICU appear to be within safe ranges and the cumulative doses were under safe thresholds documented in the literature. The main sedation agents used in PICU at the participated hospital are morphine and midazolam. Although the study shows that patients were ‘adequately sedated’, the current NISS scoring system used is not reliable alone4 and therefore, the implementation of a more accurate scoring such as Comfort-B is recommended for more reliable interpretations and better control of sedation.

References

  1. Twite MD, Rashid A, Zuk J, Friesen RH. Sedation, analgesia, and neuromuscular blockade in the pediatric intensive care unit: survey of fellowship training programs. Pediatr Crit Care Med 2004;5:521–532. doi:10.1097/01.PCC.0000144710.13710.2E

  2. Egbuta C, Mason KP. Current State of Analgesia and Sedation in the Pediatric Intensive Care Unit. J Clin Med 2021;10:1847. Published 2021 Apr 23. doi:10.3390/jcm10091847

  3. Balit CR, LaRosa JM, Ong JS, M, et al. Sedation protocols in the pediatric intensive care unit: fact or fiction?. Transl Pediatr 2021;10:2814–2824. doi:10.21037/tp-20-328

  4. Fagioli D, Evangelista C, Gawronski O, et al. Pain assessment in paediatric intensive care: the Italian COMFORT behaviour scale [published correction appears in Nurs Child Young People. 2018 Nov 12;30:]. Nurs Child Young People 2018;30(5):27–33. doi:10.7748/ncyp.2018.e1081

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