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Analgesia and sedation in critically ill pediatric patients: an update from the recent guidelines and point of view

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Abstract

In the last decades, the advancement of knowledge in analgesia and sedation for critically ill pediatric patients has been conspicuous and relevant. Many recommendations have changed to ensure patients’ comfort during their intensive care unit (ICU) stay and prevent and treat sedation-related complications, as well as improve functional recovery and clinical outcomes. The key aspects of the analgosedation management in pediatrics have been recently reviewed in two consensus-based documents. However, there remains a lot to be researched and understood. With this narrative review and authors’ point of view, we aimed to summarize the new insights presented in these two documents to facilitate their interpretation and application in clinical practice, as well as to outline research priorities in the field.

    Conclusion: With this narrative review and authors’ point of view, we aimed to summarize the new insights presented in these two documents to facilitate their interpretation and application in clinical practice, as well as to outline research priorities in the field.

What is Known:

• Critically ill pediatric patients receiving intensive care required analgesia and sedation to attenuate painful and stressful stimuli.

•Optimal management of analgosedation is a challenge often burdened with complications such as tolerance, iatrogenic withdrawal syndrome, delirium, and possible adverse outcomes.

What is New:

•The new insights on the analgosedation treatment for critically ill pediatric patients delineated in the recent guidelines are summarized to identify strategies for changes in clinical practice.

•Research gaps and potential for quality improvement projects are also highlighted.

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Abbreviations

ANI:

Analgesia Nociception Index

BIS:

Bispectral index

CAPD:

Cornell Assessment of Pediatric Delirium

ECMO:

Extra corporeal membrane oxygenation

IWS:

Iatrogenic withdrawal syndrome

NIPE:

Newborn Infant Parasympathetic Evaluation Index

NMBA:

Neuromuscular blocking agent

NSAID:

Non-steroidal anti-inflammatory drug

pCAM-ICU:

Pediatric confusion assessment method for the intensive care unit

pEEG:

Processed electroencephalogram

PICU:

Pediatric intensive care unit

PK:

Pharmacokinetic

RRT:

Renal replacement therapy

SOS-PD :

Sophia Observation Withdrawal Symptoms–Pediatric Delirium Scale

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Authors and Affiliations

  1. Pediatric Anesthesia and Intensive Care Unit, Department of Woman’s and Child’s Health, IRCCS University Hospital of Bologna Policlinico S. Orsola, Bologna, Italy

    Maria Cristina Mondardini

  2. Cardiovascular Critical Care Unit, Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Francesca Sperotto

  3. Pediatric Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padua, Padua, Italy

    Marco Daverio & Angela Amigoni

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  1. Maria Cristina Mondardini
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  2. Francesca Sperotto
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  3. Marco Daverio
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  4. Angela Amigoni
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All authors contributed to the narrative review conception and design. The first draft of the manuscript was written by the first author (MCM), and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Angela Amigoni.

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Mondardini, M.C., Sperotto, F., Daverio, M. et al. Analgesia and sedation in critically ill pediatric patients: an update from the recent guidelines and point of view. Eur J Pediatr 182, 2013–2026 (2023). https://doi.org/10.1007/s00431-023-04905-5

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