therapeutic drug levels and minimize periods of agitation. Propofol
is discouraged for children <3 years of age and when used in older
population, should be used briefly due to concerns for Propofol
infusion syndrome.[ 19 - 20 ] Both Etomidate and Dexmedetomidine
are felt to inhibit sympathetic system, therefore suppressing some
of the native compensatory mechanisms in sepsis.[ 21 ]
Regardless of the choice of drugs, sedation should be titrated to
comfort, using standardly accepted sedation scores, as over
sedation and particularly neuromuscular blockade actually
correlate with more negative, long-term outcomes.
- Management of hyperglycemia: Glucose targets in the pediatric
population are similar to adults and are designed to avoid both
hypo and overt hyperglycemia. Stress state and addition of
corticosteroids, both induce hyperglycemia. Previous protocols for
tight glycemic control have
shown to worsen outcomes, due to induced hypoglycemic states.
More moderate protocols are now recommended, with goal
glucose <180 mg/dl.
- Use of blood products has partly been discussed, particularly
transfusion targets for PRBCs in unstable, septic children. Other
products
