Procedural sedation and analgesia in the pediatric intensive care unit

Children frequently experience more painful, stressful, and traumatic medical procedures and treatments in the pediatric intensive care unit (PICU) than when they are hospitalized in general wards. An essential part of care in the PICU is providing critically ill children with appropriate sedation and analgesia. Finding the perfect combination of adequate analgesia and sufficient sedation in a patient group with a wide range of ages, sizes, and developmental stages can be challenging. Administration of sedatives and analgesics to critically ill patients may be challenging and complicated by unpredictable pharmacokinetics (PK) and pharmacodynamics (PD). It is important to keep in mind that optimal agents for procedural sedation and analgesia (PSA) differ from those used for long-term sedation in the PICU. In addition to pharmacological measures, different non-pharmacological methods can be applied and have been shown to be effective for pain relief in children. Efforts are being made to improve PSA management with the use of national surveys, recommendations and guidelines.