Sedation and analgesia for critically ill children

Abstract

Effective analgesia and sedation in the paediatric intensive care unit (PICU) encompasses the provision of physical comfort and caring for the psychological well-being of critically ill children. In the UK the most commonly used sedative and analgesic agents for critically ill children are midazolam and either morphine or fentanyl. Consensus clinical practice guidelines for the provision of sedation and analgesia in critically ill children were published in 2006 by the UK Paediatric Intensive Care Society, and an ESPNIC position statement on clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children was published in 2016: Despite this, considerable variation in practice persists. Pain experienced early in life may result in long-term changes in neurosensory function and there are also concerns that sedative and analgesic agents may themselves be associated with developmental neurotoxicity, particularly amongst neonates, and adverse psychological outcomes in survivors of critical care. Validated tools for assessment of withdrawal syndrome and delirium are available and this article will briefly discuss these and how to use them in clinical practice. The most important single factor in reducing avoidable psychological morbidity in survivors of PICU is to minimize the administered doses of sedative and analgesic agents.