sedation (conscious sedation/sedation/analgesia), is a drug-induced depression
of consciousness during which patients are able to respond purposefully to
verbal commands or light touch. Monitoring of respiratory status is important,
as there is a potential risk of airway compromise. Deep sedation/analgesia is a
drug-induced depression of consciousness during which patients cannot be
easily aroused but respond purposefully after repeated verbal or painful
stimulation. Patients lose the ability to protect their airway and require
assistance for airway protection. Lastly, general anesthesia is a drug induced
loss of consciousness during which patients are not arousable and are unable
to protect their airway. Impairment of cardiovascular or respiratory function is
also common [5,6].^
Adult critical care literature highlights the importance of implementing a
standard sedation/analgesia algorithm in order to reduce total sedative use and
ICU morbidity. Sedation protocols may decrease morbidity, ICU length of stay,
duration of mechanical ventilation, decreased duration of opioid and
benzodiazepine infusion and total duration of sedative exposure [4] Several
pediatric studies have also demonstrated the impact of sedation on a child’s
ICU course. The RESTORE trial was a prospective evaluation of sedation
related adverse events among 22 PICUs. Inadequate pain or sedation
management comprised 70% of reported adverse events in mechanically
ventilated patients [7]. Gupta examined interrupted versus continuous sedative
infusions in a randomized control trial and found days on ventilator, duration of
ICU stay, total dose of midazolam was significantly increased in the continuous
infusion group. Additionally the percentage of awake days was significantly
less in continuous infusion [8].^
The relationship between sedation regimens and mechanical ventilation
has been examined in several studies. In the randomized control trial by
Randolph et al, sedative use in the first 24 hours of weaning was found to
strongly influence length of time on the ventilator and extubation failure in