Sedation Practices in the PICU: An Unexpected Casualty of COVID-19

Abstract

Pediatric intensivists often use an "analgosedation" approach in mechanically ventilated children. By prioritizing analgesia and minimizing sedation, patients experience less delirium. However, when COVID-19 surged, our pediatric intensive care unit providers were tasked with caring for adults with severe acute hypoxemic respiratory failure (AHRF). As documented in the literature, adults with COVID-19-AHRF received significantly higher doses of sedatives than matched cohorts with non-COVID-19 AHRF. Surprisingly, when the pediatric intensive care unit returned to caring for children, a quality review showed that we were unintentionally using far more sedatives than that prior to COVID-19. This experience is not unique to our institution, or to COVID-19. Lingering effects of crisis care can persist beyond the event itself. We seek to share our experience in order to extend the conversation regarding the unexpected effects of crises on best practices and to stress the need for high-quality research on interventions to support mental health and resilience in frontline healthcare providers.

Figure 1.

Sedation exposure in the pediatric intensive care unit. Total cumulative benzodiazepine dose (converted into midazolam equivalents in mg/kg per patient per day) in mechanically ventilated children increased ~2 sd above daily average during the week of Hurricane Harvey (A) and for the months in the aftermath of COVID-19 (B).