Analgesia and sedation practice in children in intensive care in Australia and New Zealand: A survey

Objectives To describe the contemporary practice of analgesia and sedation in children in intensive care units (ICU) in Australia and New Zealand (ANZ). Design A unit level survey. Setting ICUs in Australia and New Zealand between December 2024 and May 2025. Participants ICUs that admit more than 150 children annually and report data to the Australian and New Zealand Paediatric Intensive Care Registry. Main outcome measures Protocols for analgesia, sedation, delirium and iatrogenic withdrawal syndrome (IWS) as well as medication preferences and quality initiatives related to analgesia and sedation. Results Fourteen of the 16 eligible ICUs completed the survey. Analgesia and sedation protocols were reported by seven tertiary paediatric ICUs (7/9) compared to two general units (adult/paediatric and combined neonatal/paediatric ICUs) (2/5). The preferred first line analgesic was morphine, and first line sedative was dexmedetomidine, however reported sedative preferences varied. Protocolised pain assessment tools were universally reported, sedation assessments were reported in 13/14 units, iatrogenic withdrawal assessments in 12/14 units and less than half (6/14) reported protocolised delirium assessment. Protocols for neuromuscular blocking agent use were also reported in 6/14 ICUs. Multidisciplinary quality assurance groups were infrequent (4/14 ICUs). Conclusions Paediatric analgesia and sedation protocols were reported in nearly two-thirds of ICUs in ANZ that care for children and more commonly in tertiary PICUs. Analgesia, sedation and drug withdrawal protocolisation were common however, less so for delirium. Despite the multiple components of analgesia and sedation management, governance and quality assurance programs were uncommon.