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J Pediatr Intensive Care 2015; 04(04): 188-193
DOI: 10.1055/s-0035-1563543
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Optimizing Sedation Management to Promote Early Mobilization for Critically Ill Children

Mary Saliski
1   Department of Anesthesiology and Critical Care Medicine, Charlotte Bloomberg Children's Center, Baltimore, Maryland, United States
,
Sapna R. Kudchadkar
1   Department of Anesthesiology and Critical Care Medicine, Charlotte Bloomberg Children's Center, Baltimore, Maryland, United States
› Author Affiliations
Further Information

Publication History

07 December 2014

29 December 2014

Publication Date:
01 September 2015 (online)

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Abstract

Achieving successful early mobilization for the intubated, critically ill child is dependent on optimizing sedation and analgesia. Finding the fine balance between oversedation and undersedation can be challenging. The ideal is for a child to be lucid and interactive during the daytime and demonstrate normal circadian rhythm for sleep with rest at night. Being alert during the day facilitates active participation in therapy including potential ambulation, while decreasing the risk of delirium during mechanical ventilation. An active state during the day with frequent mobilization promotes restorative sleep at night, which brings with it multiple benefits for healing and recovery. Indeed, this ideal may not be physiologically feasible given a child's critical illness and trajectory, but defining it as the “gold standard” for early mobilization provides a consistent goal for the pediatric intensive care unit (PICU) hospitalization. As such, goal-directed, patient-specific sedation plans are integral to creating a culture of mobility in the PICU. We review currently available sedation strategies for mechanically ventilated children for successful implementation of early mobilization in the PICU, as well as pharmacologic considerations for specific classes of sedative–analgesics.

Keywords

rehabilitation - early mobilization - sleep - sedation - analgesia - delirium - pediatric - intensive care units - mechanical ventilation
 

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