Abstract
Atropine has almost disappeared from routine anaesthetic practice, but is increasingly recommended and used for intubation of critically ill children. We sought to determine the influences on atropine use during critical care intubation by a group of 61 paediatric intensivists from eight countries in Europe and North and South America, using a Delphi approach. In addition, we wished to establish whether it was possible to give recommendations for atropine use. An expert panel examined clinical indicators or outcomes and atropine-prescribing practices, which potentially could influence atropine prescription. The indicators were formatted into Likert-type questionnaires before being answered by the intensivists in two rounds of structured questioning, with qualitative and quantitative feedback. A stratification into frequent, intermediate and infrequent users, was constructed, according to the frequency of atropine use. Consensus was considered to have been achieved for a median score of ≥7 with ≥75% agreement. We found three areas of consensus: personal practice determines atropine use; there is a risk of death during critical care intubation; and the presence of fever should not influence atropine use. A near-consensus was reached that children are at risk of haemodynamic disturbance. Importantly, there was no consensus that the use of atropine prevents either bradycardia or reduces the risk of hypotension or death during intubation. The use of atropine to prevent haemodynamic instability during intubation remains controversial and consensus was not forthcoming, despite agreement on several risk factors. In particular, the usefulness of atropine to prevent bradycardia, hypotension or death during critical care intubation remains uncertain.