Sedation and Analgesia Practices in Pediatric Intensive Care Units: A Survey of 27 Centers from Turkey

Abstract

The management and monitoring of sedoanalgesia are important measures in improving the efficacy of procedures and mechanical ventilation, as well as reducing adverse effects and preventing withdrawal syndrome, and delirium in pediatric intensive care units (PICUs). As there is an ongoing need to clarify the best approach to sedoanalgesia in PICUs, we aimed to analyze the current approaches in sedation, analgesia, withdrawal, and delirium practices among PICUs in Turkey. Twenty-seven PICUs completed the survey. Only 9 (33.3%) and 13 (48.1%) centers had a written protocol for analgesia and sedation, respectively. Paracetamol and a combination of midazolam and fentanyl were preferred in 51.8 and 40% of the PICUs for postoperative periods, respectively, and 81.4% of the units preferred ketamine for short-term interventions. For prolonged sedation in mechanically ventilated children, a combination of benzodiazepines and opiates were the most preferred first-line agents with a very high percentage of 81.4%, whereas ketamine and dexmedetomidine accounted for 62.9 and 18.5%, respectively, as second-line options. Although sedative and analgesic agent preferences were comparable with the relevant literature, we should focus on developing a standardized, evidence-based algorithm for sedation and analgesic drugs.

Keywords

analgesia - delirium - pediatric intensive care - sedation - withdrawal

The specialists are:

Tolga Koroglu and Ozgur Mart (PICU, Dokuz Eylül University, Izmir, Turkey); Oguz Dursun (PICU, Akdeniz University, Antalya, Turkey); Gokhan Kalkan and Sahin Sincar (PICU, Gazi University, Ankara, Turkey); Nilufer Yalindag Ozturk and Emel Uyar (PICU, Marmara University, İstanbul, Turkey); Esra Sevketoglu and Ulkem Kocoglu Barlas (PICU, Bakırköy Dr. Sadi Konuk Research and Training Hospital, İstanbul, Turkey); Tanıl Kendirli (PICU, Ankara University, Ankara, Turkey); Ayse Berna Anil (PICU, Izmir University of Health Sciences Tepecik Training and Research Hospital, İzmir, Turkey); Hasan Agin (PICU, S.B.U. Dr. Behçet Uz Children’s Education And Research Hospital, İzmir, Turkey); Caglar Odek (PICU, Aydin University, İstanbul, Turkey); Resul Yilmaz (PICU, Selcuk University, Konya, Turkey); Halil Keskin (PICU, Ataturk University, Erzurum, Turkey); Capan Konca (PICU, Adıyaman University, Adıyaman, Turkey); Hasan Serdar Kihtir (PICU, Antalya Training and Research Hospital, Antalya, Turkey); Serhat Emeksiz (PICU, Ankara Children’s Hematology and Oncology Training and Research Hospital, Ankara, Turkey); Mehmet Alakaya (PICU, Mersin University, Mersin, Turkey); Arda Kilinc (PICU, Dagkapı State Hospital, Diyarbakır, Turkey); Fulya Kamit (PICU, Denizli State Hospital, Denizli, Turkey); Mey Talip (PICU, Okmeydanı Training and Research Hospital, İstanbul, Turkey); Alper Koker (PICU, Hatay State Hospital, Hatay, Turkey); Osman Yesilbas (PICU, Bezmialem University, İstanbul, Turkey); Murat Tanyildiz (PICU, Mersin City Hospital, Mersin, Turkey); Ilknur Tolunay (PICU, Adana City Hospital, Adana, Turkey); Arzu Oto (PICU, Health Sciences University Bursa Higher Specialization Training And Research Hospital, Bursa, Turkey); Pınar Yazici Ozkaya (PICU, Ege University, İzmir, Turkey); Mutlu Uysal (PICU, Dr. Sami Ulus Child Health and Disease Training and Research Hospıtal, Ankara, Turkey); Ozlem Temel Koksoy (PICU, Konya Training and Research Hospital, Konya, Turkey); Filiz Yetimakman (PICU, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey); Ufuk Yukselmis (PICU, Dr. Lutfi Kirdar Kartal Training and Research Hospital, İstanbul, Turkey); Ercument Petmezci (PICU, Yeni Yuzyil University, İstanbul, Turkey); Muhterem Duyu (PICU, Medeniyet University Goztepe Training and Research Hospital, İstanbul, Turkey); Selman Kesici (PICU, Hacettepe University, Ankara, Turkey); Arslan (PICU, Derince Training and Research Hospital, Kocaeli, Turkey); Murat Kangin (PICU, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey); Suleyman Bayraktar (PICU, Haseki Training and Research Hospital, Istanbul, Turkey).

Publikationsverlauf

Eingereicht: 03. Juni 2020

Angenommen: 15. August 2020

Artikel online veröffentlicht:
18. September 2020

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