Optimal sedation in pediatric intensive care patients: a systematic review

Abstract

This study suggests that sedation in the PICU is often suboptimal and seldom systematically evaluated. Oversedation is more common than undersedation. As oversedation may lead to longer hospitalization, tolerance, and withdrawal, preventing oversedation in pediatric intensive care deserves greater attention.

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

“…Non-pharmacological strategies should be carried out and checked every time since the admission to the unit. 1,2,[4][5][6][7] Among the non-pharmacological measures are minimization of noise in the unit -which must be as silent as possible; utilization of adequate luminosity to promote an adequate sleep-awake cycle -through less light during nighttime; promoting time to rest and sleep to maintain a circadian orientation; concentrating, as much as possible, the procedures on daytime; keeping the patient in a comfortable position, with the use of cushions, for example; stimulating the presence of companions; maintaining good communication between everyone and the medical team. The use of video-therapy and music-therapy are also procedures to promote comfort to these patients.…”

“…The use of video-therapy and music-therapy are also procedures to promote comfort to these patients. 1,2,[4][5][6][7] Management of pain/sedation The International Association for the Study of Pain defines pain as a sensorial and emotional, unpleasant experience, associated with an actual or potential lesion to tissues. In the ICU, we can distinguish between two types of pain: (1) acute pain, including procedure and post-operative pain; and (2) prolonged pain -which is pain caused by a disease (like peritonitis, mechanical ventilation, tubes and drains etc.…”

“…The main indications to these medications are: to better manage pain, anxiety, and agitation; promote amnesia; facilitate synchrony with the mechanical ventilation; avoid loss of catheters and endotracheal tube; and reduce cellular metabolism. [1][2][3][4] However, in spite of helping to manage these conditions, it is still difficult to reach adequate level of sedation and analgesia, avoiding excesses and subdose. An ideal level of sedation is described as an estate on which the patient is sleepy, responding to environmental stimuli, without risks and excessive movements.…”

“…For better management of these patients, the use of scales and protocols of analgesia and sedation, associated with mild sedation and daily interruption, is associated with lower use and shorter duration of sedation, mechanical ventilation, and length of hospital and ICU stay (as described by the Society of Critical Care Medicine -SCCM). [1][2][3][4] oBJective The objective is to review the main aspects of sedation and analgesia in pediatric intensive care units, including the use of scales for patient management, daily interruption, adequate level of sedation, abstinence syndrome, and delirium. In the end, to promote the use of protocols, with the main aspects to lower the use of sedatives through the use of sedation and analgesia scales, improving multidisciplinary communication and lowering hospital and length of ICU stay.…”

Prevalence and Risk Factors for Upper Airway Obstruction after Pediatric Cardiac Surgery

“…Intensive care unit regimens for narcotic and sedative administration vary widely across different institutions, and optimal practice is the subject of much debate among pediatric critical care physicians. [17][18] We speculate that centers with a more aggressive initial approach to postoperative analgesia and sedation, or have lower thresholds for neuromuscular blockade, may have lower incidences of post-extubation upper airway obstruction (but also, possibly, higher incidences of over-sedation). We therefore suggest that postoperative extrathoracic upper airway obstruction has potential as an outcome variable in future studies of optimal sedation practices in pediatric patients undergoing cardiac surgery.…”