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Safety and Monitoring During Pediatric ICU Sedation

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Sedation and Analgesia for the Pediatric Intensivist

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Abstract

Optimal sedation in the pediatric intensive care unit (ICU) is ideal but unfortunately far from the reality. Ensuring adequate sedation begins with appropriate assessment and treatment of pain, followed by assessment of sedation and agitation using developmentally appropriate and validated observational assessment tools. Safety during analgesia and sedation, whether for prolonged mechanical ventilation or a quick procedure, can further be achieved with standard use of cardiorespiratory monitoring and end-tidal capnography. Objective sedation monitoring through analysis of heart rate variability or processed electroencephalography (EEG) measures, such as the Bispectral Index score or amplitude-integrated EEG, has been investigated with varying levels of thoroughness. Current evidence does not support stand-alone use of objective monitoring devices; instead, analgesia and sedation management is dependent on integration of information from multiple sources, including observational assessment tools. In addition, current practice guidelines emphasize the importance of implementing standardized, goal-directed sedation protocols, which is currently lacking in many ICUs.

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Authors and Affiliations

  1. Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Kaitlin M. Best

  2. Department of Nursing & Clinical Care Services, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Kaitlin M. Best

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  1. Associate Professor of Pediatrics, Emory University School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Children’s Healthcare of Atlanta at Egleston, Atlanta, GA, USA

    Pradip P. Kamat

  2. Professor of Pediatrics/Pediatric Critical Care, University of Louisville, “Just For Kids” Critical Care Center, Norton Children’s Hospital, Louisville, KY, USA

    John W. Berkenbosch

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Best, K.M. (2021). Safety and Monitoring During Pediatric ICU Sedation. In: Kamat, P.P., Berkenbosch, J.W. (eds) Sedation and Analgesia for the Pediatric Intensivist. Springer, Cham. https://doi.org/10.1007/978-3-030-52555-2_2

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