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Review
. 2017 Oct;33(10):1703-1710.
doi: 10.1007/s00381-017-3520-0. Epub 2017 Sep 6.

Analgosedation in paediatric severe traumatic brain injury (TBI): practice, pitfalls and possibilities

N Ketharanathan  1   2 , Y Yamamoto  3 , U Rohlwink  4 , E D Wildschut  5 , M Hunfeld  5 , E C M de Lange  3 , D Tibboel  5
Affiliations
Review

Analgosedation in paediatric severe traumatic brain injury (TBI): practice, pitfalls and possibilities

N Ketharanathan et al. Childs Nerv Syst. 2017 Oct.

Abstract

Analgosedation is a fundamental part of traumatic brain injury (TBI) treatment guidelines, encompassing both first and second tier supportive strategies. Worldwide analgosedation practices continue to be heterogeneous due to the low level of evidence in treatment guidelines (level III) and the choice of analgosedative drugs is made by the treating clinician. Current practice is thus empirical and may result in unfavourable (often hemodynamic) side effects. This article presents an overview of current analgosedation practices in the paediatric intensive care unit (PICU) and addresses pitfalls both in the short and long term. We discuss innovative (pre-)clinical research that can provide the framework for initiatives to improve our pharmacological understanding of analgesic and sedative drugs used in paediatric severe TBI and ultimately facilitate steps towards evidence-based and precision pharmacotherapy in this vulnerable patient group.

Keywords: Analgesia; Paediatric; Pharmacology; Sedation; Traumatic brain injury.

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Conflict of interest statement

Conflict of interest

No conflict of interest to declare.

Funding

N. Ketharanathan received research funding from Sophia Children’s Hospital Research Fund (SSWO).

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