BACKGROUND: Management and monitoring of pain and sedation to reduce discomfort as well as side effects, such as over- and under-sedation, withdrawal syndrome and delirium, is an integral part of pediatric intensive care practice. However, the current state of management and monitoring of analgosedation across European pediatric intensive care units (PICUs) remains unknown. The aim of this survey was to describe current practices across European PICUs regarding the management and monitoring of pain and sedation. METHODS: An online survey was distributed among 357 European PICUs assessing demographic features, drug choices and dosing, as well as usage of instruments for monitoring pain and sedation. We also compared low- and high-volume PICUs practices. Responses were collected from January to April 2021. RESULTS: A total of 215 (60% response rate) PICUs from 27 European countries responded. Seventy-one percent of PICUs stated to use protocols for analgosedation management, more frequently in high-volume PICUs (77% vs 63%, p = 0.028). First-choice drug combination was an opioid with a benzodiazepine, namely fentanyl (51%) and midazolam (71%) being the preferred drugs. The starting doses differed between PICUs from 0.1 to 5 mcg/kg/h for fentanyl, and 0.01 to 0.5 mg/kg/h for midazolam. Daily assessment and documentation for pain (81%) and sedation (87%) was reported by most of the PICUs, using the preferred validated FLACC scale (54%) and the COMFORT Behavioural scale (48%), respectively. Both analgesia and sedation were mainly monitored by nurses (92% and 84%, respectively). Eighty-six percent of the responding PICUs stated to use neuromuscular blocking agents in some scenarios. Monitoring of paralysed patients was preferably done by observation of vital signs with electronic devices support. CONCLUSIONS: This survey provides an overview of current analgosedation practices among European PICUs. Drugs of choice, dosing and assessment strategies were shown to differ widely. Further research and development of evidence-based guidelines for optimal drug dosing and analgosedation assessment are needed.

Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA USA

Department of Paediatrics and Inherited Metabolic Disorders 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Pediatric and Adolescent Medicine University Clinic Carl Gustav Carus Dresden Germany

Department of Pediatric Cardiology and Intensive Care Medicine Hannover Medical School Hannover Germany

Department of Physiology and Pharmacology Karolinska Institutet and Karolinska University Hospital Stockholm Sweden

Department of Woman's and Child's Health IRCCS University Hospital of Bologna Policlinico S Orsola Bologna Italy

Department Woman Mother Child Lausanne University Hospital Lausanne Switzerland

Institute of Higher Education and Research in Healthcare Faculty of Biology and Medicine University of Lausanne Lausanne Switzerland

Institute of Pharmacology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Intensive Care and Department of Paediatric Surgery Erasmus Medical Center Sophia Children's Hospital Rotterdam The Netherlands

Pediatric Anesthesia and Intensive Care Unit Department of Woman's and Child's Health IRCCS University Hospital of Bologna Policlinico S Orsola Bologna Italy

Pediatric Intensive Care Unit Department of Pediatric Surgery • Erasmus MC Sophia Children's Hospital University Medical Center Rotterdam Rotterdam The Netherlands

Pediatric Intensive Care Unit Department of Woman's and Child's Health University Hospital of Padua Padua Italy

Crit Care. 2022 May 16;26(1):139. doi: 10.1186/s13054-022-03992-4. PubMed

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Correction to: Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey