Sedation in the pediatric intensive care unit: Challenges, outcomes, and future strategies in the united states

Abstract

Sedation and analgesia are required on a daily basis for infants and children in the pediatric intensive care unit (PICU). Regardless of the patient’s age, cognitive level, underlying medical condition, or comorbid conditions, various factors may result in agitation, anxiety, and pain during the PICU process. One of the challenges of the PICU is the variability that is presented in patient type (age, weight, comorbid conditions, acute illness), procedure type and duration, and location (in the PICU versus off-site). The procedures may be brief (burn dressing changes, placement of central venous or arterial cannulae) or prolonged (mechanical ventilation) as well as non-painful requiring only sedation (imaging) or painful requiring both sedation and analgesia. When considering the patient who requires mechanical ventilation, the need for procedural sedation may last for days or even weeks as children may require prolonged sedation to overcome the pain and anxiety associated with the presence of an endotracheal tube and the requirement for ongoing mechanical ventilation. The pain and anxiety may be further magnifi ed by psychological factors including periodic separation from parents, disruption of the day-night cycle and alterations of normal sleep patterns, unfamiliar people, the noise of imposing machines and monitoring devices, fear of death, and loss of self-control.