Indiana University School of Medicine; Riley Hospital for Children Indianapolis, Indiana, United States
Abstract:
Objective: To characterize the current approach to sedation, analgesia, iatrogenic withdrawal syndrome and delirium in Pediatric Cardiac Intensive Care Units.
Design: A convenience sample survey of practitioners at institutions participating in the Pediatric Cardiac Critical Care Consortium conducted September to December 2020. Setting: Pediatric cardiac intensive care units. Measurements and Main
Results: Survey responses were received from 33 of 42 institutions contacted. Screening for pain and agitation occurs commonly and frequently. A minority of responding centers (39%) have a written analgesia management protocol/guideline. A minority (42%) of centers have a written protocol for sedation. Screening for withdrawal occurs commonly, although triggers for withdrawal screening vary. Only 42% of respondents have written protocols for withdrawal management. Screening for delirium occurs “always” in 46% of responding centers, “sometimes” in 36% of centers and “never” 18%. Nine participating centers (27%) have written protocols for delirium management.
Conclusions: Our survey identified that most responding pediatric cardiac ICUs lack a standardized approach to the management of analgesia, sedation, iatrogenic withdrawal and delirium. Screening for pain and agitation occurs regularly, while screening for withdrawal occurs fairly frequently, and screening for delirium is notably less consistent. Only a minority of centers use written protocols or guidelines for the management of these problems. We believe that this represents an opportunity to significantly improve patient care within the pediatric cardiac ICU.
