Analgesia, sedation and delirium management in adult critically ill burns: a survey

Objectives
This study aims to assess the current practices of analgesia, sedation and delirium monitoring and treatment strategies in burn ICUs.

Methods
We designed a web survey consisting of four parts: physician and institutional demographics, management of pain, sedation and delirium in burn patients. The questionnaire was distributed by email to 230 burn specialists worldwide.

Results
Physician and Institutional demographics.
A total of 40 respondents worldwide submitted valuable data in the 2 months period, equivalent to a response rate of 16%.Of all respondents, 20 (50%) were from Europe, 7 (17.5%) from North America, 6 (15%) from Africa and 12 (30%) from other regions (including Western Pacific, Southeast Asia, Central and South Americas and Eastern Mediterranean). 20 (50%) respondents were intensivists/anaesthesists, 18 (45%) surgeons and 2 (5%) other professionals.

Analgesia.
The vast majority (92.5%) reported they routinely screen severe burns for pain, but 27.5% declared no specific score is used. The most popular analgesics were opioids, specifically morphine (75%) and fentanyl (72.5%). Among non-pharmacological approaches, the most used were psychological support (62.5%). Only a minority of respondents apply hypnosis (12.5%).

Sedation.
A significant percentage (70%) affirmed they routinely screen their patients for sedation, but 30% do not use a specific scale. The sedatives used more often were midazolam (72.5%) and propofol (55%). 20% of specialists affirmed to use dexmedetomidine frequently in their routine practice.

Delirium.
The majority (70%) affirmed to routinely assess burn patients for delirium, but 57.5% do not use a specific score. Burn specialists affirmed to prevent delirium in their patients combining pharmacological and non-pharmacological approaches (62.5%).

Conclusions
Awareness concerning pain, sedation and delirium is increasing among burn specialists. Efforts are still needed to implement guidelines and best practices.