(864) Pediatric Critical Care Providers' Reported Sedative Practices

Introduction: Sedation is commonly required for critically ill children, but little is known about why and how pediatric intensive care unit (PICU) providers choose sedative agents. Existing sedation guidelines have also not taken into consideration the use of newer agents such as dexmedetomidine.

Methods: A survey was developed to evaluate PICU providers’ sedation practices. The survey was distributed electronically in English via the Pediatric Acute Lung Injury and Sepsis Investigator network listserv. Descriptive analyses were generated.

Results: 253 respondents completed the survey. Dexmedetomidine was most chosen as the first-choice sedative infusion for intubated patients with primary respiratory failure, on extracorporeal support or those with primary neurologic disease. Fentanyl was most often chosen as the first-choice sedative infusion for intubated patients with sepsis and those following surgical repair for congenital heart disease. For patients on opiate infusions, most respondents (63%) reported not routinely cycling to another medication to mitigate tolerance. Respondents reported regularly starting intermittent medications prior to extubation to facilitate weaning off sedative infusions (82% reported doing so “very often” or greater), with methadone being the most common intermittent opiate and lorazepam the most common intermittent benzodiazepine medications used. Dexmedetomidine was reported to be used by 99.6% of respondents, most commonly as continuous for sedation for intubated (100%) and non-intubated (98%) patients. Propofol was used by almost all (97%) of respondents, including for procedural sedation (96%), sedation for 6 or more hours for intubated patients (85%) or intubation induction (65%). 56% of respondents reported having a maximum duration of propofol duration; the median maximum was 48 hours (IQR 24-48). Most (71%) respondents reported never having seen a patient with propofol-related infusion syndrome (PRIS).

Conclusions: Fentanyl and dexmedetomidine are the most reported first-line medications for intubated children. Dexmedetomidine is routinely used despite not having been included in sedation guidelines and being relatively understudied. Propofol is also regularly used, with most PICU providers reporting never having seen PRIS.