infants and children [9]. Payen et al also found continuous intravenous
sedation was an independent risk factor for prolonged mechanical ventilation
after multivariate analysis [10]. Sedation regimens can also impact unplanned
extubations. Another review highlighted prospective studies that demonstrated
a significant reduction in rates of unplanned extubation following institution of a
sedation algorithm [11]. The best practice recommendations included
establishment of a sedation protocol and regular assessment of level of
sedation to help reduce the rates of unplanned extubations, however a specific
algorithm or sedation assessment tool was not identified [11]. Hartman, et al
published a systematic review of pediatric sedation regimens in the intensive
care unit in Pediatric Critical Care Medicine. The primary objective was to
identify and evaluate the quality of evidence supporting sedatives and sedation
regimens commonly used in the PICU to facilitate mechanical ventilation.
Thirty-nine studies were included in the review, representing 39 sedation
algorithms and 20 scoring systems used to evaluate level of sedation. Although
sedation regimens have been used extensively across neonatal and pediatric
intensive care units, the data are lacking as to the appropriate dosing, safety
and protocols for use [12].
(^)
III. Common Analgesics
A. Opioids
The CNS has 4 primary opioid receptors: μ, κ, δ, σ. μ agonists are most
commonly used in pain management regimens. Opioids exert their clinical
effects as a sedative and analgesic. Side effects include respiratory
depression, nausea, vomiting, delayed gastric emptying, delayed intestinal
motility, pruritus, constipation, miosis, tolerance, and physical dependence.