Manuel A Baarslag1, Karel Allegaert1,2, Catherijne A J Knibbe3,4, Monique van Dijk1, Dick Tibboel1. 1. Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 2. Department of development and regeneration, KU Leuven, Belgium. 3. Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands. 4. Division of Pharmacology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands.
Abstract
OBJECTIVE: This review addresses sedation management on paediatric intensive care units and possible gaps in the knowledge of optimal sedation strategies. We present an overview of the commonly used sedatives and their pharmacokinetic and pharmacodynamic considerations in children, as well as the ongoing studies in this field. Also, sedation guidelines and current sedation strategies and assessment methods are addressed. KEY FINDINGS: This review shows that evidence and pharmacokinetic data are scarce, but fortunately, there is an active research scene with promising new PK and PD data of sedatives in children using new study designs with application of advanced laboratory methods and modelling. The lack of evidence is increasingly being recognized by authorities and legislative offices such as the US Food and Drug Administration (FDA) and European Medicines Agency (EMA). CONCLUSION: The population in question is very heterogeneous and this overview can aid clinicians and researchers in moving from practice-based sedation management towards more evidence- or model-based practice. Still, paediatric sedation management can be improved in other ways than pharmacology only, so future research should aim on sedation assessment and implementation strategies of protocolized sedation as well.
OBJECTIVE: This review addresses sedation management on paediatric intensive care units and possible gaps in the knowledge of optimal sedation strategies. We present an overview of the commonly used sedatives and their pharmacokinetic and pharmacodynamic considerations in children, as well as the ongoing studies in this field. Also, sedation guidelines and current sedation strategies and assessment methods are addressed. KEY FINDINGS: This review shows that evidence and pharmacokinetic data are scarce, but fortunately, there is an active research scene with promising new PK and PD data of sedatives in children using new study designs with application of advanced laboratory methods and modelling. The lack of evidence is increasingly being recognized by authorities and legislative offices such as the US Food and Drug Administration (FDA) and European Medicines Agency (EMA). CONCLUSION: The population in question is very heterogeneous and this overview can aid clinicians and researchers in moving from practice-based sedation management towards more evidence- or model-based practice. Still, paediatric sedation management can be improved in other ways than pharmacology only, so future research should aim on sedation assessment and implementation strategies of protocolized sedation as well.
Authors: Antje Neubert; Manuel Alberto Baarslag; Monique van Dijk; Joost van Rosmalen; Joseph F Standing; Yucheng Sheng; Wolfgang Rascher; Deborah Roberts; Jackie Winslade; Louise Rawcliffe; Sara M Hanning; Tuuli Metsvaht; Viviana Giannuzzi; Peter Larsson; Pavla Pokorná; Alessandra Simonetti; Dick Tibboel Journal: BMJ Open Date: 2017-06-21 Impact factor: 2.692