Pain and Sedation Management: 2018 Update for the Rogers' Textbook of Pediatric Intensive Care

Objectives: To review important articles on pain, sedation, sleep, and delirium in the field of pediatric critical care published subsequent to the fifth edition of the Rogers' Textbook of Pediatric Critical Care. Data Sources: The U.S. National Library of Medicine PubMed was searched for a combination of the term "pediatric" and the following terms: "sedation," "sedation protocol," "pain," "pain score," "neuromuscular blockade," "delirium," and "sleep." Titles and abstracts resulting from the search were screened for full-text review and potential inclusion. Authors also included recent key articles they were aware of with direct relevance to the topics. Study Selection and Data Extraction: The authors selected articles for inclusion based on their relevance and clinical significance if they were published subsequent to the fifth edition of the textbook. Data Synthesis: Selected articles were grouped together by categories similar to specific sections of the pain and sedation chapter in the textbook and included pain, sedation, sleep, and delirium. Conclusions: Recent research into pediatric pain and sedation management has focused on optimizing the choice of sedative medications, in particular by increasing the use and understanding of nonopioid and nonbenzodiazepine options such as ketamine and alpha-2 agonists. Delirium has emerged as a significant morbidity in the critically ill pediatric patient, and recent articles have concentrated on the use of validated screening tools to determine the epidemiology and risk factors in specific populations, including patients with cardiac disease and those receiving extracorporeal membrane oxygenation. A consistent theme in the most recent literature is the role of titrated but effective sedation, quality improvement to increase delirium recognition, and optimizing the pediatric intensive care environment to promote sleep.