Pain and Sedation Management in Mechanically Ventilated Children

Overview

Journal J Pediatr Intensive Care

Date 2019 May 22

PMID 31110854

Authors

Lauren Sorce

Shari Simone

Affiliations

Soon will be listed here.

Abstract

Assessing and managing pain and agitation in critically ill children can be challenging. Multiple factors contribute to the challenges of management, including prior medication exposure, surgical and procedural interventions, pharmacokinetics, and age-related pharmacodynamics making the population heterogeneous. Therefore, individualizing treatment approaches embedded with frequent assessments is likely to improve the management of pain and agitation in critically ill children. Novel approaches to manage pain and agitation continue to evolve and will require ongoing evaluation prior to widespread adoption.

References

Arenas-Lopez S, Riphagen S, Tibby S, Durward A, Tomlin S, Davies G . Use of oral clonidine for sedation in ventilated paediatric intensive care patients. Intensive Care Med. 2004; 30(8):1625-9. DOI: 10.1007/s00134-004-2319-0. View

Chrysostomou C, Di Filippo S, Manrique A, Schmitt C, Orr R, Casta A . Use of dexmedetomidine in children after cardiac and thoracic surgery. Pediatr Crit Care Med. 2006; 7(2):126-31. DOI: 10.1097/01.PCC.0000200967.76996.07. View

Walker J, Maccallum M, Fischer C, Kopcha R, Saylors R, McCall J . Sedation using dexmedetomidine in pediatric burn patients. J Burn Care Res. 2006; 27(2):206-10. DOI: 10.1097/01.BCR.0000200910.76019.CF. View

Buck M, Willson D . Use of dexmedetomidine in the pediatric intensive care unit. Pharmacotherapy. 2007; 28(1):51-7. DOI: 10.1592/phco.28.1.51. View

Phan H, Nahata M . Clinical uses of dexmedetomidine in pediatric patients. Paediatr Drugs. 2007; 10(1):49-69. DOI: 10.2165/00148581-200810010-00006. View

Schweickert W, Kress J . Strategies to optimize analgesia and sedation. Crit Care. 2008; 12 Suppl 3:S6. PMC: 2391265. DOI: 10.1186/cc6151. View

Hartman M, McCrory D, Schulman S . Efficacy of sedation regimens to facilitate mechanical ventilation in the pediatric intensive care unit: a systematic review. Pediatr Crit Care Med. 2009; 10(2):246-55. DOI: 10.1097/PCC.0b013e31819a3bb9. View

Czaja A, Zimmerman J . The use of dexmedetomidine in critically ill children. Pediatr Crit Care Med. 2009; 10(3):381-6. DOI: 10.1097/PCC.0b013e3181a3191f. View

Hosokawa K, Shime N, Kato Y, Taniguchi A, Maeda Y, Miyazaki T . Dexmedetomidine sedation in children after cardiac surgery. Pediatr Crit Care Med. 2009; 11(1):39-43. DOI: 10.1097/PCC.0b013e3181b062d7. View

10.

Dahmani S, Brasher C, Stany I, Golmard J, Skhiri A, Bruneau B . Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies. Acta Anaesthesiol Scand. 2010; 54(4):397-402. DOI: 10.1111/j.1399-6576.2009.02207.x. View

11.

Lin H, Faraklas I, Sampson C, Saffle J, Cochran A . Use of dexmedetomidine for sedation in critically ill mechanically ventilated pediatric burn patients. J Burn Care Res. 2010; 32(1):98-103. DOI: 10.1097/BCR.0b013e318203332d. View

12.

Deeter K, King M, Ridling D, Irby G, Lynn A, Zimmerman J . Successful implementation of a pediatric sedation protocol for mechanically ventilated patients. Crit Care Med. 2011; 39(4):683-8. DOI: 10.1097/CCM.0b013e318206cebf. View

13.

Gupta K, Gupta V, Jayashree M, Muralindharan J, Singhi S . Randomized controlled trial of interrupted versus continuous sedative infusions in ventilated children. Pediatr Crit Care Med. 2011; 13(2):131-5. DOI: 10.1097/PCC.0b013e31820aba48. View

14.

Le K, Moffett B, Ocampo E, Zaki J, Mossad E . Impact of dexmedetomidine on early extubation in pediatric cardiac surgical patients. Intensive Care Med. 2011; 37(4):686-90. DOI: 10.1007/s00134-011-2140-5. View

15.

Hoy S, Keating G . Dexmedetomidine: a review of its use for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation. Drugs. 2011; 71(11):1481-501. DOI: 10.2165/11207190-000000000-00000. View

16.

Burbano N, Otero A, Berry D, Orr R, Munoz R . Discontinuation of prolonged infusions of dexmedetomidine in critically ill children with heart disease. Intensive Care Med. 2011; 38(2):300-7. PMC: 3741648. DOI: 10.1007/s00134-011-2441-8. View

17.

Lam F, Ransom C, Gossett J, Kelkhoff A, Seib P, Schmitz M . Safety and efficacy of dexmedetomidine in children with heart failure. Pediatr Cardiol. 2012; 34(4):835-41. DOI: 10.1007/s00246-012-0546-7. View

18.

Fagin A, Palmieri T, Greenhalgh D, Sen S . A comparison of dexmedetomidine and midazolam for sedation in severe pediatric burn injury. J Burn Care Res. 2012; 33(6):759-63. DOI: 10.1097/BCR.0b013e318254d48e. View

19.

Barr J, Fraser G, Puntillo K, Wesley Ely E, Gelinas C, Dasta J . Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2012; 41(1):263-306. DOI: 10.1097/CCM.0b013e3182783b72. View

20.

Carney L, Kendrick J, Carr R . Safety and Effectiveness of Dexmedetomidine in the Pediatric Intensive Care Unit (SAD-PICU). Can J Hosp Pharm. 2013; 66(1):21-7. PMC: 3583774. DOI: 10.4212/cjhp.v66i1.1208. View