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Lancet Respir Med. 2015 Oct;3(10):796-812. doi: 10.1016/S2213-2600(15)00331-8. Epub 2015 Sep 24.

Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study.

Collaborators (244)

Kiechl-Kohlendorfer U, Trinkl A, Deindl P, Wald M, Rigo V, Dussart A, Dierckx E, Coppens S, Papadouri T, Kiilsapaa B, Metsvaht T, Metsäranta M, Nikolajev K, Saarela T, Peltoniemi O, Tammela O, Lehtonen L, Savagner C, Sevestre A, Alexandre C, Bouchon-Guedj N, Saumureau S, Grosse C, Jouvencel P, Ramful D, Clamadieu C, Mourdie J, Montcho Y, Cambonie G, Di Maio M, Patural H, Asrtuc D, Norbert K, Bouchera K, Lang M, Galene Gromez S, Hamon I, Nolent P, Ntwari RC, Lallemant C, Chary Tardy AC, Pelluau S, Roue JM, Picaud JC, Camelio A, Tourneux P, Saint-Faust M, Morville P, David A, Theret B, Frédérique M, Topf G, Menendez-Castro R, Fujiwara-Pichler E, Deeg KH, Anatolitou F, Baroutis G, Papazafeiratou C, Giannakopoulou C, Baltogianni M, Delivoria V, Sterpi M, Saklamaki-Kontou M, Dimitriou G, Charitou A, Thomaidou A, Chatziioannidis I, Salvanos I, Pirelli A, Poggiani C, Fasolato V, Cristofori G, Gomirato S, Allegro A, Alfiero M, Biban P, Bertolini A, Golin R, Franco E, Molinaro G, Federica V, Rossini R, Garetti E, Faraoni M, Dani C, Germini C, Braguglia A, Benigni G, Azzali A, Santa B, Romoli R, Carrera G, Miria N, Savant P, Cossu MA, Giancarlo G, Tameliene R, Cassar R, Bos A, Van Kaam A, Brouwer M, Van Lingen R, Bambang Oetomo S, Sivertsen W, Nakstad B, Solhjell K, Flagstad G, Salvesen B, Nessestrand IA, Nordhov M, Anderssen SH, Wasland K, Danielsen K, Kristoffersen LM, Ytterdahl Bergland U, Borghild Stornes R, Andresen J, Solberg R, Hochnowski K, Terpinska E, Kociszewska-Najman B, Melka A, Głuszczak E, Niezgoda A, Borszewska-Kornacka MK, Witwicki JM, Korbal P, Ramos H, Garcia P, Machado C, Clemente F, Costa M, Trindade C, Salazar A, Martins Barroso L, Resende C, Afonso ME, Torres J, Maciel P, Nunes JL, Neve Dos Santos VA, Melgar Bonis A, Euba Lopez A, Tapia Collados C, Jesus Ripalda M, Solis Sanchez G, Martin Parra B, Botet F, Fernandez Trisac JL, Elorza Fernandez MD, Arriaga Redondo M, Bargallo Ailagas E, Saenz P, Lopez Ortego P, Ventura P, Galve Z, Perez Ocon A, Crespo Suarez P, Dianez Vega G, San Feliciano L, Herranz Carillo G, Esteban Diez I, Reyné M, Garcia Borau MJ, De Las Cuevas I, Couce ML, González Carrasco E, Montoro Exposito A, Concheiro Guisan A, Luna Lagares S, Sanchez Redondo MD, Hellström Westas L, Moren S, Norman E, Olsson E, Åberg E, Printz G, Turner M, McBride T, Bomont R, Webb D, Saladi M, Thirumurugan A, Brooke N, Skene C, Bilolikar H, Noble V, Vora A, Thompson F, Deorukhkar A, El-Refee S, McIntyre J, Millman G, Reed J, Babirecki M, Kumar D, Yadav M, O'Brien M, Gasiorowski ER, Rawlingson C, Shastri A, Tibby S, Walsh S, Azzopardi D, Soe A, MaCrae D, Eyre E, Menon G, Gupta S, James A, Surana P, Adams E, Wolf A, Maxwell N, Wagstaff M, Mann R, Kumar Y, Quinn M, Jones Dyson S, Mannix P, Morris K, Ewer A, Gurusamy K, Deshpande S, Alexander J, Blake K, Kumar S, Oddie S, Ohadike P, McKechnie L, Gibson D, Shirsalkar A, Suryanarayanan B, Hubbard M, Lal M, Ali I, Shah D, Sketchley S, Gupta R, Schofield J, Ezzat M, Mupanemunda R, Gallagher A, Kronsberg S.

Author information

1
Hôpital Armand Trousseau, Service des Urgences Pédiatriques, Faculté de Médecine, Paris, France; INSERM U1153, Faculté de Médecine, Paris, France; Université Pierre et Marie Curie, Faculté de Médecine, Paris, France. Electronic address: ricardo.carbajal@trs.aphp.fr.
2
Örebro University, Faculty of Medicine and Health, Örebro, Sweden.
3
Hôpital Armand Trousseau, Service des Urgences Pédiatriques, Faculté de Médecine, Paris, France; INSERM U1153, Faculté de Médecine, Paris, France.
4
University of Leicester, Leicester, UK.
5
Complexo Hospitalario Universitario de A Coruña, Coruña, Spain.
6
Telemark Hospital, Skien, Norway.
7
Aristotle University of Thessaloniki, Neonatal Intensive Care Unit, Thessaloniki, Greece.
8
University of Oulu, Oulu, Finland.
9
Maternidade Dr Alfredo da Costa, Lisbon, Portugal.
10
University of Padua, Padua, Italy.
11
Archbishop Makarios Hospital, Nicosia, Cyprus.
12
Mater Dei Hospital, Msida, Malta.
13
Tallinn Children's Hospital, Tallin, Estonia.
14
Erasmus MC-Sophia Kinderziekenhuis, Rotterdam, Netherlands.
15
Lithuanian University of Health Sciences, Kaunas Perinatal Center, Kaunas, Lithuania.
16
Erasme Hospital, Brussels, Belgium.
17
Medical University of Vienna, Vienna, Austria.
18
Children's Memorial Health Institute, Warsaw, Poland.
19
Cnopf'sche Kinderklinik, Nürnberg, Germany.
20
Karolinska Institute, Stockholm, Sweden.
21
University of Tennessee, Memphis, TN, USA.

Erratum in

Abstract

BACKGROUND:

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.

PMID:
26420017
DOI:
10.1016/S2213-2600(15)00331-8
[Indexed for MEDLINE]

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