Sedation and Analgesia in a Pediatric Intensive Care Unit (PICU): Point of Care Study

Background: Variety of sedation methods are applied for children treated in the PICU without clear evidence about their usefulness. Opioids and benzodiazepines have been a standard analgesic and sedative combination. Currently newer agents, like a2-adrenergic agonists have been proposed.

Objective: To assess the principal sedative and analgesic drug choices for patients treated in a pediatric medical/surgical ICU.

Methods: The study was conducted in a 24 bed complex of two intensive care units, surgical and medical, at one institution. A one day analysis was chosen. The medications, their methods of administration, and doses were analyzed.

Results: There were 24 patients treated in both wards on the day of study, 20 of them required mechanical respiratory support. The majority of patients (13) were up to 3 days after surgery. The most common analgesic drug was morphine used in 16 children (in 9 as bolus, in 5 as infusion) administered for a median of 2 days (range 1-7), followed by non-opioid drugs (paracetamol and metamizole) in 6 cases, and sufentanil by infusion in 2. The major medication for sedation was midazolam (14 patients, in 5 as an infusion) administered for a median of 3 days (range 1-22), followed by dexmedetomidine infusion in 9 patients (median duration 4 days, range 1-22 days, mean 8 days). The doses of morphine were in the lower therapeutic range (mostly 0,1 mg/kg bolus), doses of dexmedetomidine were from 0,6 to 1,5 micrograms/kg/hr. Oral methadone was administered in 2 children, in one in combination with clonidine. Ten patients were treated concomitantly with 2 analgesic/sedative drugs, five 3 medications, four were receiving 4 drugs, and five one.

Conclusion: In our study morphine, midazolam, dexmedetomidine were main analgesic and sedative drugs used in the PICU. Dexmedetomidine was used for longer periods of time than suggested by the manufacturer and literature.