Objective Out-of-hospital cardiac arrest (OHCA) is a devastating event that can have ongoing neurological and functional sequelae for survivors, which impact their whānau/family and society. Information on long-term survival remains incomplete. We aimed to understand the long-term neurological, functional, and health-related quality of life outcomes and survival of patients with OHCA at 24 months in New Zealand. Design We performed a preplanned prospective, longitudinal cohort study. Setting New Zealand Participants Participants enrolled in the Targeted Therapeutic Mild Hypercapnia after resuscitated Cardiac Arrest (TAME trial) in New Zealand. Main outcome measures Participants had a comprehensive follow-up at 6 and 24 months using the Glasgow Outcome Scale-Extended to determine neurological outcome as well as multiple other patient-centred functional outcome assessment tools. Results We included all 200 TAME participants enrolled in New Zealand, of whom 194 (97%) had 24-month data. There was no difference in the primary and secondary TAME study outcomes between groups, with overall 56.3% of participants having a favourable neurological outcome at 6 months. In the New Zealand subpopulation, functional and health-related quality of life status at 24 months was not worse than at 6 months for most survivors, with very few participants reporting more than slight disability. Conclusions Among New Zealand TAME trial participants, neurological and functional outcomes measured across multiple domains generally remained stable or improved between 6 and 24 months. These findings provide important information for survivors of OHCA, their whānau/family, clinicians, and researchers on the timing and trajectory of neurological and functional recovery.
Objective To evaluate the 24-months cost-effectiveness of selective decontamination of the digestive tract (SDD) versus standard care in mechanically ventilated Intensive Care Unit (ICU) patients. Design Within‑trial cost‑effectiveness analysis using linked administrative healthcare datasets. Setting Nineteen Australian ICUs participating in the Australian Selective Decontamination of the Digestive Tract in the ICU (SuDDICU Australia) cluster crossover randomised trial (2018–2021). Participants 2845 adult patients enrolled from New South Wales, Australia with 24‑month follow‑up (SDD, n=1252; standard care, n=1593). Interventions SDD plus standard care versus standard care alone. Main Outcome measures All‑cause mortality at 24 months; life‑years gained; healthcare resource use; healthcare costs (Australian dollars [A$]) and cost-effectiveness expressed as incremental cost-effectiveness ratio (cost per life-year gained); subgroup analyses in acute brain injuries/conditions patients. Results At 24 months, mortality (SDD: 521/1252 [41.6%] vs standard care: [697/1593] 43.8%; p=.25), and survival probabilities (hazard ratio 0.93, 95% confidence interval: 0.83-1.04; p=.22) did not differ between groups. SDD was associated with shorter median mechanical ventilation duration (4.0 vs 4.3 days) and lower mean non-SDD antibiotics use (11.7 vs 12.9) versus standard care. Mean per-patient healthcare costs were higher with SDD (A$294,529 vs A$268,493), yielding an incremental cost-effectiveness ratio of A$669,726 per life-year gained and ∼1% probability of SDD being cost-effectiveness at the Australian willingness-to-pay threshold. Incremental cost-effectiveness ratio was lower in traumatic brain injury patients (A$169,887 per life-year gained). Conclusion In mechanically ventilated ICU patients, SDD use didn’t improve 24-month survival and healthcare costs were higher, resulting in low probability of cost-effectiveness within Australian healthcare context.
The 2026 American Heart Association/American College of Cardiology pulmonary embolism guideline sets out a severity-based framework and a range of reperfusion strategies, including catheter-directed and mechanical therapies that most regional intensive care units in Australia cannot deliver on site. For the lowest-risk and the most severe high-risk patients, management is largely determined by severity and is similar wherever the patient presents. The difficult group is the patient with intermediate-high or early high-risk pulmonary embolism who may deteriorate but does not yet warrant immediate thrombolysis, and who often carries a bleeding risk that thrombolysis would worsen. The absence of on-site advanced therapy matters most for this group. The guideline helps here by setting out the available therapies and their limits and by defining when to involve a tertiary centre. Systemic thrombolysis remains the only on-site reperfusion option for a regional unit, and for the deteriorating patient without prohibitive bleeding risk, it is a reasonable choice consistent with current best-available evidence. We set out how a regional unit might reason through these decisions and offer a management table as one worked example. The table is a local adaptation and has not been prospectively validated.
Background An obesity paradox has been described in general and selected intensive care populations, whereby obese patients experience lower mortality than healthy-weight patients despite physiological disadvantages. Whether this paradox exists among a selected group of patients with acute hypoxaemic respiratory failure (AHRF) requiring mechanical ventilation remains uncertain. We examined the association between body mass index (BMI) and in-hospital mortality in a large, contemporary cohort of mechanically ventilated intensive care unit (ICU) patients with AHRF. Methods This retrospective cohort study used the ANZICS Adult Patient Database (2020–2024). We included unplanned adult ICU admissions requiring invasive mechanical ventilation with AHRF, defined as admission PaO2/FiO2 <300 mm Hg. The primary outcome was in-hospital mortality, assessed using hierarchical logistic regression after adjustment for confounders. The nonlinear association between respiratory failure severity and mortality was modelled using restricted cubic splines. The secondary outcomes included organ support use, tracheostomy receipt, duration of ventilation, and ICU and hospital length of stay. Results Among 40 352 eligible patients, overall unadjusted in-hospital mortality was 21% (22.7% in healthy-weight patients). After adjustment, mortality was lower in preobese patients (BMI 25–29.9 kg/m2; adjusted odds ratio [aOR] 0.92, 95% confidence interval [CI] 0.85–0.99), obesity class 1 (BMI 30–34.9 kg/m2; aOR 0.85, 95% CI 0.79–0.93), and obesity class 2 (BMI 35–39.9 kg/m2; aOR 0.88, 95% CI 0.79–0.98). The association weakened after adjustment and did not extend to obesity class 3 (BMI ≥40 kg/m2). There was no significant interaction between BMI and respiratory failure severity (p = 0.08). Conclusion Among patients ventilated for AHRF, overweight and moderately obese BMI categories were associated with modestly lower in-hospital mortality. This association is conditional on the decision to intubate and is compatible with a modest degree of selection bias. The conclusions should be interpreted as a prognostic association within ventilated patients rather than the presence of obesity improving survival.
Objective:To evaluate the suitability of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU) for use in critical care registries across multiple continents. Design:A federated external validation study. Setting:Intensive care units (ICUs) belonging to 12 critical care registries on five continents. Participants:Individuals over the age of 18 years who were admitted to participating ICUs during the 2023 calendar year. Readmissions within the same hospital encounter and interhospital transfers were excluded. Interventions:None. Main outcome measures:The primary outcome was all-cause in-hospital mortality. A secondary analysis considered ICU mortality. Results:12 registries participated (three from Africa, four from Asia, one from Oceania, two from Europe and two from South America). In total, 494,705 admissions were included from 546 ICUs in 13 countries. Seven registries systematically reported hospital outcomes and were included in the primary analysis. Discrimination was acceptable (pooled area under the receiver operating characteristic curve [AUROC] 0.76 [95% CI 0.72-0.80]). Calibration and overall model fit varied between registries (Brier scores 0.09-0.14). In the secondary analysis of ICU outcomes in all 12 registries, discrimination remained acceptable but with higher variation between registries (pooled AUROC 0.73 [0.69-0.77]). Calibration and overall model fit also varied widely (Brier scores 0.07-0.46). Conclusions:SMS-ICU may be used as an index of illness severity in international intensive care populations. This may facilitate international collaborative research and synthesis of findings in systematic reviews and meta-analyses.
Objective:We aimed to investigate patients discharged alive from hospital following an ICU admission for drug overdose and whether exposure of prior overdose-related ICU admission was associated with a future ICU readmission. Design setting participants:This multicentre registry-based study included data from 167 ICUs across Australia that reported to the Australia New Zealand Intensive Care Society Adult Patient Database. We included all adult patients (≥16 years) discharged alive from the hospital after an ICU admission for an overdose between 1st July 2018 and 31st December 2023. The exposure of interest was an overdose-related ICU admission in the six months prior to the index ICU admission. Main outcome measures:The primary outcome was all-cause ICU readmission within the following six months. The secondary outcome was ICU readmission due to an overdose within six months. We used mixed-effects multivariable logistic regression to adjust for confounders and identify risk factors for ICU readmission. Results:Of 30,125 index episodes of ICU overdose admissions (25,604 individuals), 2555 (8.5%) had an overdose-related ICU admission in the prior six months. They had higher rates of all-cause ICU readmission compared to those without a prior overdose-related ICU admission (40.9% vs. 8.9%; p < 0.001). After accounting for other factors including younger age, female sex, Indigenous status, higher SOFA scores, chronic respiratory disease, cirrhosis, dialysis dependence and frailty, an overdose in the six months prior to the index ICU admission was associated with ICU readmission in the following six months (OR = 1.93; 95%CI: 1.59-2.34; p < 0.001). Conclusions:This large Australian registry-based study found that in patients discharged alive from hospital following an ICU admission for overdose, patients with a history of prior ICU admission for overdose had almost double the risk for ICU readmission. These findings have implications for risk stratification, clinical decision-making and resource planning.
Objective:To evaluate the characteristics, antecedents, and outcomes of in-hospital cardiac arrests (IHCAs) in a Singaporean tertiary hospital. Design:We conducted a retrospective review of electronic medical records of all IHCAs that occurred in the general ward from January to December 2022 at Changi General Hospital. Based on pre-arrest characteristics, IHCAs were categorised as "potential suboptimal end-of-life planning (SELP)", "potentially predictable", or "sudden and unexpected". Main outcome measures:Primary outcomes were IHCA incidence and survival to hospital discharge. Secondary outcomes included the proportion of potential SELP cases and the frequency of pre-arrest extent of care (EOC) documentation. Results:There were 50 IHCAs among 52 617 admissions (0.95/1000 admissions). The median age was 72.5 (interquartile range [IQR], 63-81) years, and 82% had a Clinical Frailty Scale score of ≥ 4. Thirty (60%) arrests fulfilled criteria for potential SELP, while EOC documentation was present in 30% of patients. Five patients (10%) survived to hospital discharge. Factors associated with survival included shorter cardiopulmonary resuscitation duration (p = 0.004), witnessed arrests (p = 0.019), and sustained return of spontaneous circulation (ROSC) (p = 0.005). Conclusions:Our data corroborate that witnessed arrests, shorter downtime, and sustained ROSC are associated with better outcomes. However, the high prevalence of potential SELP and low rates of documented EOC reveal critical gaps in end-of-life planning within a frail inpatient population. Earlier, routine EOC discussions may help align care with patient goals, optimising resource utilisation and reducing potentially avoidable IHCAs.
Objective:To determine the effect of initial rhythm on 6-month survival with favourable functional outcomes in patients supported with extracorporeal cardio pulmonary resuscitation (ECPR) for in-hospital cardiac arrest and out-of-hospital cardiac arrest (IHCA and OHCA).Design/Setting/Participants: This multicentre cohort study used secondary data from the EXCEL registry, a binational extracorporeal membrane oxygenation (ECMO) database across Australia and New Zealand. Adults receiving ECPR between February 2019 and December 2022 were included. Main outcome measures:The primary outcome was 6-month survival with a favourable functional outcome, defined using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 (12-item survey). Secondary outcomes included: survival (intensive care unit [ICU], hospital, 90- and 180-day), duration of ECMO and ventilation, ICU and hospital length of stay, and work status at 6 months. Results:Among 249 patients, 123 (49.4%) had an initial shockable rhythm and 126 (50.6%) had a nonshockable rhythm. Overall, 16% (40/249) survived with favourable functional outcomes. Rates were higher in the shockable group (21% vs. 11%, p = 0.031), despite the non-shockable group having more witnessed arrests (98 vs. 90%, p = 0.005) and shorter low-flow times (46.8 vs 65.5 min, p = 0.003). Survivors with a nonshockable rhythm had longer ICU (19.8 vs. 12.7 days, p = 0.028) and hospital stays (39.6 vs. 27.0 days, p = 0.003). Unemployment due to health issues at 6 months was similar between the shockable (14/40 [35%]) and nonshockable (12/32 [37.5%]) groups (p = 0.826). Conclusions:An initial shockable rhythm was associated with higher 6-month survival with favourable functional outcomes after ECPR. Larger studies are needed to confirm whether rhythm-guided selection may improve patient outcomes.
Background:Accurate predictors of neurological outcome after in-hospital cardiac arrest (IHCA) remain limited. Methods:We conducted a systematic review and meta-analysis of 15 studies (n = 4948 adults) to identify peri-arrest factors associated with favourable neurological outcomes in IHCA survivors. Study quality was assessed using the QUIPS tool and evidence certainty was rated with GRADE. Results:A favourable neurological outcome was associated with pre-arrest factors such as male sex (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.13-1.78, Level of Evidence (LOE): low), established ischaemic heart disease (OR: 1.84, 95% CI: 1.12-3.02 LOE: low), acute myocardial infarction diagnosis upon hospital admission (OR: 2.14 95% CI: 1.53-2.99 LOE: low), acute heart failure (OR: 1.99, 95% CI: 1.42-2.78 LOE: low) and arrests in telemetry units (OR: 1.34, 95% CI: 1-1.78 LOE: low). Initial shockable rhythm (OR: 3.0, 95% CI: 2.3-3.9, LOE: moderate), cardiac-related causes (OR: 2.12, 95% CI: 1.54-2.92, LOE: low to moderate) and shorter cardiopulmonary resuscitationduration (standardised mean difference: -0.62, 95% CI: -0.89, -0.35) were also associated with improved neurological recovery. Post-arrest interventions such as emergent coronary catheterisation (OR: 4.55, 95% CI: 2.11-9.82, LOE: low), pulmonary artery catheterisation monitoring (OR: 3.84, 95% CI: 1.51-9.75, LOE: low), and extracorporeal membrane oxygenation after return of spontaneous circulation (OR: 1.71, 95% CI: 1.20-2.43, LOE: low) were associated with better neurological outcomes. The overall quality of included studies was generally of low certainty, limited by moderate bias and substantial heterogeneity. Conclusions:Early detection and management of reversible cardiac causes in IHCA are associated with improved patient outcomes. This study identifies peri-arrest factors associated with favourable neurological outcomes in adult survivors of IHCA who were discharged alive. All findings and interpretations are limited to this conditional population and should not be extrapolated to the broader IHCA cohort. While these findings offer valuable insights for risk stratification and protocol development, high-quality prospective studies are needed to validate these associations and confirm their clinical significance.
Objective:To evaluate whether structured education combined with target-aligned arterial pressure alarm limits improved alignment between documented achieved and clinician-prescribed mean arterial pressure (MAP) during vasopressor therapy. Design:Multicentre pre-post quality-improvement evaluation. Setting:Three tertiary intensive care units in Australia and New Zealand. Participants:Adult intensive care unit patients receiving continuous vasopressor infusion with invasive arterial pressure monitoring, a documented clinician-prescribed MAP target, and available MAP and alarm-limit data during 24 h of vasopressor therapy. Intervention:A centre-level bundled implementation strategy comprising structured education, target-aligned arterial pressure alarm-limit configuration, and bedside implementation support, without mandating MAP targets or altering prescribing practice. Main outcome measures:The primary outcome was MAP gap, defined as documented achieved MAP minus prescribed MAP at four-hourly observation points during vasopressor therapy. Secondary outcomes included alarm window configuration, inter-site variation in MAP gap, exposure to MAP <60 mmHg, and exploratory short-term clinical outcomes. Results:After the intervention, alarm window width was narrower and more consistently aligned with prescribed MAP targets (median difference in width -40 mmHg, 95% confidence interval [CI]: -45 to -35). The post-intervention phase was associated with a lower documented MAP gap (median difference: -4 mmHg, 95% CI: -5.0 to -3.0; p < 0.001), reflecting reduced overshoot above target. The proportion of observations with MAP <60 mmHg did not increase. Clinical outcome data were exploratory and incompletely captured. Conclusions:Structured education combined with target-aligned arterial pressure alarm limits and bedside implementation support was associated with improved alignment between documented achieved and clinician-prescribed MAP. Further evaluation should include continuous pressure-time exposure, vasopressor dose, alarm burden, and longitudinal adherence to target-aligned alarm limits.
Background:Acute stress impairs attention and procedural performance in high-acuity environments. Whether brief mindfulness-based interventions are feasible and affect performance in intensive care unit (ICU) simulation training is unknown. Objectives:To evaluate the feasibility of a brief mindfulness-based intervention before simulated ultrasound-guided central venous access device (CVAD) insertion. Design setting and participants:Single-centre pilot randomised feasibility study at a tertiary ICU simulation centre. Twelve of thirteen ICU registrars with prior CVAD experience were randomised 1:1 to mindfulness or an active control. Intervention:A 3-min recorded mindfulness meditation focused on breath awareness and attentional regulation, or a time-matched active control (standardised observation chart review), delivered immediately prior to simulation. Main outcome measures:Feasibility thresholds: recruitment ≥80%, adherence ≥90%, data completeness ≥95%, and assessor blinding. Exploratory outcomes included procedural performance (checklist, global rating scale, and total score), physiological arousal (heart rate and blood pressure), psychological state anxiety (STAI-State), confidence, and cognitive workload (NASA-TLX). Results:All feasibility thresholds were met (recruitment [92%], adherence, and data completeness [100%, respectively]; blinding maintained). Mindfulness produced greater transient reductions in heart rate (-12.4 vs -5.3 beats/min) and systolic blood pressure (-13.5 vs -3.7 mmHg). STAI-State decreased in the mindfulness group but was unchanged in controls. Postsimulation confidence was higher in the mindfulness group (mean 13.7 vs 11.8). Procedural performance was numerically lower in the mindfulness group across all domains (total score 41.3 vs 52.0), and critical procedural errors were more frequent (4/6 vs 1/6). Confidence intervals were wide throughout, reflecting the small sample. Conclusions:A brief preprocedural mindfulness intervention was feasible and transiently reduced physiological arousal and state anxiety, but did not improve procedural performance; scores were numerically lower in the mindfulness group and critical errors were more frequent, though chance imbalance cannot be excluded given the small sample. These findings support progression to a larger, multicentre, adequately powered trial.
Objective:With global population growth and ageing, intensive care demand is increasing. This retrospective study, the PrognostICate (Prognostication of ICU Data) Study, aimed to predict annual ICU admissions, ICU length of stay (ICULOS), and ICU bed demand in Australia and New Zealand to 2040, stratified by sex, age, ventilation status, and admission type. Setting:Retrospective bi-national data analysis (2006-2025) using the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS-APD). Participants:All adult (>16 years) ICU patients. Intervention:Forecasting models including Poisson regression, autoregressive integrated moving average (ARIMA), logarithmic regression, and exponential smoothing (ETS) were applied. Data were combined with population projections from the Australian Bureau of Statistics and Stats NZ. Model accuracy was tested using out-of-time cross-validation. Main outcome measures:Annual ICU admissions, ICULOS and ICU bed demand until 2040. Results:A total of 3,055,786 ICU admissions were analysed. In Australia, ICULOS is projected to decrease from 3.44 days (2006) to 3.21 days in 2040 (95% PI [Prediction Interval] 2.72-3.83), while increasing among ventilated patients from 4.71 to 5.61 days (95% PI 5.34-5.98). In New Zealand, ICULOS is predicted to rise from 3.26 (2006) to 3.30 days (95% PI 2.08-5.33), and among ventilated patients from 3.92 to 7.67 days (95% PI 4.80-37.80). By 2040, ICU admissions increase by 45% in Australia and 60% in New Zealand (vs 2025). ICU bed demand is estimated at 3050 beds in Australia (9.0/100,000; 95% PI 2822-3279), up from 2372 (8.9/100,000) in 2023, and 286 beds in New Zealand (4.7/100,000; 95% PI 223-348), up from 283 (5.4/100,000) in 2023. Conclusion:ICU admissions and ICULOS among ventilated patients are projected to increase in both countries by 2040. Despite heterogeneity in ICULOS across subgroups, these findings highlight the need for stratified ICU capacity planning accounting for age, sex, admission type, and ventilation status.
Objective:To provide Australian intensive care clinicians with a pragmatic framework for the safe integration of large language models (LLMs) into intensive care unit (ICU) practise, addressing the current lack of Australian-specific guidance and limited local evidence. Design:Narrative review. Data sources:Peer-reviewed publications, preprints, and policy documents relating to LLM use in health care, with a focus on critical care applications and governance. Review methods:Evidence and expert commentary were synthesised to develop a clinician-led, risk-stratified framework for ICU implementation, with emphasis on safety, oversight, and applicability within Australian health systems. Clinical use cases, risks, governance considerations, and practical safeguards for day-to-day ICU practise were identified. Results:LLMs have potential utility in data-dense ICU environments, including summarising complex clinical information, supporting documentation, assisting clinical reasoning, and facilitating research tasks. However, evidence for LLM performance in ICU contexts remains limited, particularly in Australia. Key risks include inaccurate or fabricated outputs ("hallucinations"), bias, lack of situational awareness, privacy concerns, and over-reliance in high-stakes decision-making. We propose a risk-stratified framework that categorises LLM applications by clinical risk and reversibility, and aligns each category with proportional oversight, verification processes, and governance safeguards, emphasising clinician-in-the-loop decision-making. Conclusions:LLMs may serve as adjunctive cognitive tools in Australian ICUs when used in clearly defined, low-to intermediate-risk contexts under clinician oversight. Safe integration requires robust governance frameworks emphasising transparency, data protection, and proportionate clinician decision-making. Further Australian-based evaluation is needed before high-risk clinical applications can be considered for routine practise.
Objective:To compare total hospital costs associated with remifentanil versus fentanyl for analgosedation in mechanically ventilated intensive care unit (ICU) patients, given increasing interest in remifentanil as a feasible alternative, but limited economic evidence. Design:Cost analysis of a single-centre, prospective, randomised controlled trial (remi-fent1 RCT). Setting:Nepean Hospital ICU, New South Wales, Australia. Patients:Adult patients admitted between June 2020 and August 2021 requiring invasive mechanical ventilation (IMV) who were randomised to receive remifentanil or fentanyl as part of their analgosedation regimen. Main outcome measures:The primary outcome was total hospital bed-day costs (Australian Dollars), estimated from a healthcare payer perspective using the Australian Independent Hospital Pricing Authority National Pricing Model for the financial year 2020-2021. Health-related quality of life (HRQoL) at 6 months was measured using the generic EuroQoL 5-dimension 5-level (EQ-5D-5L) instrument. Pre-specified subgroup analyses examined age (arbitrary cut-off 65 years) and duration of IMV (arbitrary cut-off 72 h). Results:A total of 210 patients were analysed (remifentanil n = 104; fentanyl n = 106). Opioid acquisition costs were comparable between groups. Total mean hospital bed-day costs were lower in the remifentanil group compared with the fentanyl ($48,301 [$38,644-$57,958] vs. $37,012 [95% confidence interval {CI}: $27,834-$46,191]; p = 0.006). The remifentanil group was associated with lower total hospital costs in older patients (≥65 years) and in those ventilated for ≤72 h. At 6 months, 110 patients were alive, with 7 lost to follow-up, (61/103 remifentanil [59.2%] vs. 59/100 fentanyl [59.0%]; p = 0.80). Among survivors, remifentanil continued to demonstrate lower overall hospital costs, but 6-month HRQoL remained similar between groups (EQ-5D-5L index 0.83 vs. 0.87; p = 0.24). Conclusion:Remifentanil was associated with lower total hospital costs than fentanyl, without differences in survival or HRQoL at 6 months, suggesting that remifentanil may be a lower-cost alternative for analgosedation. However, the results are exploratory and require confirmation in larger, adequately powered multicentre phase-2 trials.
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.
