Sedation of the Critically Ill Child

Providing effective sedation and analgesia in infants and children admitted on a Pediatric Intensive Care Unit (PICU) is a cornerstone of daily patient care and probably one of the most challenging tasks facing PICU professionals. The wide range in age, weight and body composition, underlying medical and neurological diseases, the usually high sensory stimulatory environment, the repetitive physical stimuli related to medical therapy (e.g., physical examination, invasive procedures, and interventions) and—most importantly—the scarcity of high quality evidence applicable for daily practice may all contribute to this difficulty. A holistic comfort directed policy, including both pharmacological interventions as well as non-pharmacological strategies is promoted. For assessing comfort and/or pain several instruments are available. Particular attention should be paid to certain challenging clinical problems related to sedation, i.e. the management of refractory agitation, drug withdrawal and delirium.