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Table 2 Analgesia, sedation and paralysis drug of choice comparing PICUs according to yearly admission volume

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

Characteristics

Total responders

n = 215

PICUs < 450 admissions/year

n = 117

PICUs ≥ 450 admissions/year

n = 98

p value

Drug used as first choice for continuous analgosedationa

Opioids

a. Fentanyl

110 (51)

64 (55)

46 (47)

0.257

b. Morphine

62 (29)

32 (27)

30 (31)

0.599

c. Sufentanil

32 (15)

16 (14)

16 (16)

0.586

d. Remifentanil

3 (1)

2 (2)

1 (1)

1.000

e. Oxycodon

1 (1)

1 (1)

0 (0)

1.000

Benzodiazepines

a. Midazolam

153 (71)

90 (77)

63 (65)

0.042

b. Lorazepam

–

–

–

–

Alpha 2 agonists

a. Dexmedetomidine

24 (11)

12 (10)

12 (12)

0.645

b. Clonidine

14 (7)

8 (7)

6 (6)

0.832

Others

a. Ketamine

18 (8)

2 (2)

16 (16)

0.000

b. Propofol

5 (2)

3 (3)

2 (2)

1.000

c. Thiopentone

2 (1)

1 (1)

1 (1)

1.000

d. Chloral Hydrate

1 (1)

1 (1)

0 (0)

1.000

Drugs used in combination as first choice

Fentanyl and midazolam

81 (38)

54 (46)

27 (28)

0.004

Morphine and midazolam

36 (17)

20 (17)

16 (16)

0.881

Sufentanil and midazolam

24 (11)

10 (9)

14 (14)

0.199

Fentanyl and ketamine

12 (6)

0 (0)

12 (12)

0.000

Morphine and dexmedetomidine

9 (4)

3 (3)

6 (6)

0.306

Morphine and clonidine

9 (4)

5 (4)

4 (4)

1.000

Drug used as second choice for continuous analgosedationa

Opioids

a. Fentanyl

57 (27)

20 (17)

37 (38)

0.001

b. Morphine

57 (27)

37 (32)

20 (20)

0.064

c. Sufentanil

12 (5)

6 (5)

6 (6)

0.774

d. Remifentanil

3 (1)

2 (2)

1 (1)

1.000

e. Methadone

2 (1)

1 (1)

1 (1)

1.000

f. Alfentanil

1 (1)

1 (1)

0 (0)

1.000

Benzodiazepines

a. Midazolam

32 (15)

19 (16)

13 (13)

0.542

b. Lorazepam

13 (6)

7 (6)

6 (6)

0.966

Alpha 2 agonists

a. Dexmedetomidine

117 (54)

65 (56)

52 (53)

0.715

b. Clonidine

69 (32)

31 (27)

38 (39)

0.055

Others

a. Ketamine

120 (56)

62 (53)

58 (59)

0.363

b. Propofol

77 (36)

44 (38)

33 (34)

0.549

c. Antihistamines

13 (6)

5 (4)

8 (8)

0.262

d. Phenobarbital

4 (2)

3 (3)

1 (1)

0.627

e. Chloral Hydrate

5 (2)

2 (2)

3 (3)

0.662

f. Inhaled agents

2 (1)

2 (2)

0 (0)

0.502

Drug used during difficult analgosedationa

Opioids

a. Sufentanil

1 (1)

0 (0)

1 (1)

0.456

b. Remifentanil

3 (1)

2 (2)

1 (1)

1.000

c. Methadone

2 (1)

0 (0)

2 (2)

0.207

Benzodiazepines

a. Midazolam

2 (1)

0 (0)

2 (2)

0.182

b. Lorazepam

2 (1)

1 (1)

1 (1)

1.000

Alpha 2 agonists

a. Dexmedetomidine

74 (34)

41 (35)

33 (34)

0.833

b. Clonidine

39 (18)

19 (16)

20 (20)

0.430

Others

a. Ketamine

109 (51)

55 (47)

54 (55)

0.237

b. Propofol

92 (43)

50 (43)

42 (43)

0.986

c. Antipsychotic agents

44 (21)

16 (14)

28 (29)

0.007

d. Chloral hydrate

35 (16)

21 (18)

14 (14)

0.469

e. Inhaled agents

34 (16)

8 (7)

26 (27)

0.000

f. Antihistamines

18 (8)

7 (6)

11 (11)

0.167

g. Thiopentone

4 (2)

3 (3)

1 (1)

0.627

h. Phenobarbital

3 (1)

2 (2)

1 (1)

1.000

Drug never used for continuous analgosedationa

Opioids

a. Sufentanil

105 (49)

64 (55)

41 (42)

0.060

b. Fentanyl

36 (17)

9 (8)

27 (28)

0.000

c. Morphine

15 (7)

9 (8)

6 (6)

0.653

Benzodiazepines

a. Lorazepam

120 (56)

72 (62)

48 (49)

0.065

b. Midazolam

5 (2)

4 (3)

1 (1)

0.379

Alpha 2 agonists

a. Clonidine

57 (27)

35 (29)

22 (22)

0.217

b. Dexmedetomidine

23 (11)

13 (11)

10 (10)

0.830

Others

a. Inhaled agents

152 (71)

97 (83)

55 (56)

0.000

b. Antihistamines

101 (47)

62 (53)

39 (40)

0.054

c. Antipsychotic agents

90 (42)

60 (51)

30 (31)

0.002

d. Propofol

41 (19)

25 (21)

16 (16)

0.349

e. Ketamine

26 (12)

9 (8)

17 (17)

0.031

f. Chloral Hydrate

1 (1)

0 (0)

1 (1)

0.456

g. Phenobarbital

1 (1)

0 (0)

1 (1)

0.456

Use of NMBAs during analgosedation for subgroup of patients

184 (86)

96 (82)

88 (90)

0.107

Type of NMBA useda

Rocuronium

123 (57)

73 (62)

50 (51)

0.093

Cisatracurium

58 (27)

37 (32)

21 (21)

0.093

Vecuronium

29 (14)

16 (14)

13 (13)

0.930

Succinylcholine

14 (7)

0 (0)

14 (14)

0.000

Mivacurium

5 (2)

1 (1)

4 (4)

0.180

Pancuronium

3 (1)

2 (2)

1 (1)

1.000

Pipercuronium

3 (1)

2 (2)

1 (1)

1.000

Use of paracetamol for opioid sparing

177 (82)

95 (81)

82 (84)

0.635

  1. Data are reported as numbers and (percentages)
  2. aThe sum of percentages is more than 100% because responders could indicate more than one option