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Sedation and Analgesia Practices in Neonatal Intensive Care Units (EUROPAIN): Results from a Prospective Cohort Study

2015-10Journal article Open access
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dc.contributor.authorCarbajal, R
dc.contributor.authorEriksson, M
dc.contributor.authorBoyle, E
dc.contributor.authorAvila-Alvarez, A
dc.contributor.authorDovland Andersen, R
dc.contributor.authorSarafidis, K
dc.contributor.authorPolkki, T
dc.contributor.authorMatos, C
dc.contributor.authorLago, P
dc.contributor.authorPapadouri, T
dc.contributor.authorAttard Montalto, S
dc.contributor.authorIlmoja, ML
dc.contributor.authorSimons, S
dc.contributor.authorTameliene, R
dc.contributor.authorOvermeire, B
dc.contributor.authorBerger, A
dc.contributor.authorDobrzanska, A
dc.contributor.authorSchroth, M
dc.contributor.authorBergqvist, L
dc.contributor.authorLagercrantz, H
dc.contributor.authorAnand, K
dc.date.accessioned2016-11-04T16:16:17Z
dc.date.available2016-11-04T16:16:17Z
dc.date.issued2015-10
dc.description.abstractBACKGROUND: Neonates who are in pain or are stressed during care in the intensive care unit (ICU) are often given sedation or analgesia. We investigated the current use of sedation or analgesia in neonatal ICUs (NICUs) in European countries. METHODS: EUROPAIN (EUROpean Pain Audit In Neonates) was a prospective cohort study of the management of sedation and analgesia in patients in NICUs. All neonates admitted to NICUs during 1 month were included in this study. Data on demographics, methods of respiration, use of continuous or intermittent sedation, analgesia, or neuromuscular blockers, pain assessments, and drug withdrawal syndromes were gathered during the first 28 days of admission to NICUs. Multivariable linear regression models and propensity scores were used to assess the association between duration of tracheal ventilation (TV) and exposure to opioids, sedatives-hypnotics, or general anaesthetics in neonates (O-SH-GA). This study is registered with ClinicalTrials.gov, number NCT01694745. FINDINGS: From Oct 1, 2012, to June 30, 2013, 6680 neonates were enrolled in 243 NICUs in 18 European countries. Mean gestational age of these neonates was 35.0 weeks (SD 4.6) and birthweight was 2384 g (1007). 2142 (32%) neonates were given TV, 1496 (22%) non-invasive ventilation (NIV), and 3042 (46%) were kept on spontaneous ventilation (SV). 1746 (82%), 266 (18%), and 282 (9%) neonates in the TV, NIV, and SV groups, respectively, were given sedation or analgesia as a continuous infusion, intermittent doses, or both (p<0.0001). In the participating NICUs, the median use of sedation or analgesia was 89.3% (70.0-100) for neonates in the TV group. Opioids were given to 1764 (26%) of 6680 neonates and to 1589 (74%) of 2142 neonates in the TV group. Midazolam was given to 576 (9%) of 6680 neonates and 536 (25%) neonates of 2142 neonates in the TV group. 542 (25%) neonates in the TV group were given neuromuscular blockers, which were administered as continuous infusions to 146 (7%) of these neonates. Pain assessments were recorded in 1250 (58%) of 2138, 672 (45%) of 1493, and 916 (30%) of 3017 neonates in the TV, NIV, and SV groups, respectively (p<0.0001). In the univariate analysis, neonates given O-SH-GA in the TV group needed a longer duration of TV than did those who were not given O-SH-GA (mean 136.2 h [SD 173.1] vs 39.8 h [94.7] h; p<0.0001). Multivariable and propensity score analyses confirmed this association (p<0.0001). INTERPRETATION: Wide variations in sedation and analgesia practices occur between NICUs and countries. Widespread use of O-SH-GA in intubated neonates might prolong their need for mechanical ventilation, but further research is needed to investigate the therapeutic and adverse effects of O-SH-GA in neonates, and to develop new and safe approaches for sedation and analgesia. FUNDING: European Community's Seventh Framework Programme.pt_PT
dc.identifier.citationLancet Respir Med. 2015 Oct;3(10):796-812pt_PT
dc.identifier.doi10.1016/S2213-2600(15)00331-8pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/2573
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relationNCT01694745pt_PT
dc.subjectMAC PEDpt_PT
dc.subjectAnalgesics/therapeutic usept_PT
dc.subjectAnalgesics, Opioid/therapeutic usept_PT
dc.subjectBirth Weightpt_PT
dc.subjectConscious Sedation/methodspt_PT
dc.subjectConscious Sedation/statistics & numerical datapt_PT
dc.subjectEuropept_PT
dc.subjectGestational Agept_PT
dc.subjectHypnotics and Sedatives/therapeutic usept_PT
dc.subjectInfant, Newbornpt_PT
dc.subjectIntensive Care Units, Neonatal/statistics & numerical datapt_PT
dc.subjectMidazolam/therapeutic usept_PT
dc.subjectPropensity Scorept_PT
dc.subjectProspective Studiespt_PT
dc.subjectRespiration, Artificial/methodspt_PT
dc.subjectRespiration, Artificial/statistics & numerical datapt_PT
dc.titleSedation and Analgesia Practices in Neonatal Intensive Care Units (EUROPAIN): Results from a Prospective Cohort Studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage812pt_PT
oaire.citation.startPage796pt_PT
oaire.citation.titleLancet Respiratory Medicinept_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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