Protocolized Sedation vs Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure

The use of methadone to facilitate opioid weaning in pediatric critical care patients: a systematic review of the literature and meta‐analysis

“…Withdrawal causes well‐described adverse effects, including physiologic stressors such as fever, respiratory distress, tachycardia, hypertension, and feeding difficulties, as well as neurologic sequelae including agitation, hallucinations, and seizures, ultimately prolonging hospital stay . In a recent large randomized controlled trial (RCT) of pediatric intensive care unit (ICU) nurse‐directed sedative management, 27% of patients in the usual‐care arm had any Withdrawal Assessment Tool‐1 (WAT‐1) score consistent with withdrawal; 9% required additional treatment , suggesting a substantial burden of withdrawal with typical weaning management in current practice.…”

Pharmacotherapy during pediatric extracorporeal membrane oxygenation: a review

“…Optimal sedation and analgesia for pediatric patients in the PICU continues to be ill defined, but sedation protocols and daily sedative interruptions continue to be investigated [42][43][44]. For patients on ECMO, optimal sedation is even less defined [45] but is clearly prolonged.…”

Pharmacological sedation management in the paediatric intensive care unit

“…One year later, Curley et al . reported on the largest multicentre RCT comparing protocolized sedation with physician‐driven usual care in a mixed PICU population.…”

“…The longer acting benzodiazepine lorazepam is used much less than midazolam in the PICU but has been included in the Best Pharmaceuticals for Children Act (BPCA) Priority List . Its IV formulation contains propylene glycol (PG), which at toxic amounts can lead to lactic acidosis .…”