Pediatric Palliative Sedation Practices in the Intensive Care Unit

Abstract

Background:

Palliative sedation therapy (PST) is a tool that can mitigate suffering for dying patients. However, it is infrequently utilized, and little is known about the practice of PST in the intensive care unit (ICU).

Aim:

To explore PST practices in pediatric ICU settings.

Design/Participants:

We distributed an IRB-exempt anonymous electronic survey to American pediatric pain, palliative, and ICU providers. Survey responses were collated and descriptively reported.

Results:

Of 74 responses, many participants (62%, n = 46) were early-career physicians (≤10 years in practice) and represented the pediatric, neonatal, and cardiac ICU (34%, n = 25; 30%, n = 22; and 15%, n = 11), respectively. Most reported an institutional guideline for PST (55%, n = 41), no ethics involvement (86%, n = 64), and were unsure if a Do Not Resuscitate order was required prior to PST (55%, n = 40). Intractable pain (47%, n = 35) and refractory respiratory distress (38%, n = 28) were the most common symptoms requiring PST. For medication selection in PST initiation, opioids (78%, n = 58) and benzodiazepines (12%, n = 9) were selected as the primary drug of choice. The second most common medications chosen included benzodiazepines (63%, n = 47), opioids (12%, n = 9), dexmedetomidine (11%, n = 8), ketamine (7%, n = 5), barbiturates (4%, n = 3), and propofol (3%, n = 2). Participants reported an average comfort level of 6.4 on a Likert scale in providing PST. Overall, increased education on PST (81%, n = 60), and development of guidelines (76%, n = 56) and order sets (62%, n = 46) for PST implementation were reported as beneficial.

Conclusions:

PST practices in the ICU are varied, necessitating increased education and standardization of clinical practice.