Sedation in Critically Ill Children

Abstract

Sedation and analgesia are crucial elements in managing discomfort and facilitating critical care interventions in children. Our choice of sedative agents has a significant impact on the physiological and psychological outcomes of our patients. Oversedation and undersedation are associated with adverse events, including increased risk of Pediatric Intensive Care Unit (PICU) readmission, mortality, and longer duration of mechanical ventilation. Studies have shown significant variation in sedation and analgesia practices across different regions and specialties. Consensus clinical guidelines have been developed to standardize sedation and analgesia practices; commonly used intravenous agents include opioids (fentanyl, morphine, and remifentanil), α-2 agonists (clonidine and dexmedetomidine), benzodiazepines (particularly midazolam), ketamine, and volatile anesthetic agents (isoflurane and sevoflurane). Our goal should be to administer the smallest possible number of sedative and analgesic agents, in the lowest possible doses, for the shortest amount of time, whilst adequately controlling the pain and agitation of our patients. Aside from drug management, non-pharmacological interventions, such as family presence, music, and virtual reality, can also play a significant role in maintaining comfort in critically ill children. Validated clinical tools are available to measure sedation and to assess iatrogenic withdrawal syndrome and delirium. Daily interruption of sedatives and protocolized sedation management has been associated with a reduction in the duration of mechanical ventilation and length of PICU admission in some studies, but their effectiveness is still debated. Further research is needed to optimize sedation and analgesia practices in critically ill children. By adopting evidence-based guidelines and incorporating non-pharmacological interventions, clinicians may be able to improve patient outcomes and also reduce the incidence of adverse events.

Keywords: analgesia; delirium; pediatric intensive care (PICU); sedation; tolerance; withdrawal.