Introduction:

High quality evidence on the use of sedation and analgesia in liver transplant patients admitted to the pediatric intensive care unit (PICU) postoperatively is lacking.

Method:

An online survey concerning PICU sedation and analgesia practices was sent to pediatric liver transplant programs in the US, UK, and Australia. Calculated 95% confidence intervals (CIs) for a proportion of a small, finite population (N = 32).

Results:

Survey response rate was 28/32 (88%). Only 32% of them had a specific sedation protocol. 79% of programs reported respiratory status, 96% hemodynamic status, 54% delirium and 39% transplant surgeon preference as influencers of medication selection. 29% (95% CI: 23 - 35%) of PICUs reported receiving patient intubated. In intubated patients, opioid [50% (95% CI: 43 - 57%)] and dexmedetomidine [32% (95% CI: 26 - 38%)] infusions were the most used single agents; dexmedetomidine infusion with as needed (PRN) boluses of opioids used in 36% (95% CI: 30 - 42%) of programs. In pateints with early extubation, PRN boluses of opioids were used in 46% (95% CI: 39 - 53%), or dexmedetomidine with PRN opioids in 25% (95% CI: 19 - 31%) of programs. Acetaminophen with opioids were most used oral agents 86% (95% CI: 81 - 91%).

Conclusion:

We report a wide variability in sedation-analgesia practices in the postoperative liver transplant patient admitted to the PICU. Survey results show that the pediatric intensivists have a unique opportunity to develop standardized, evidence based algorithms to better manage patients in the immediate post-transplant period.