SEDATION AND PAIN MANAGEMENT IN PEDIATRIC INTENSIVE CARE : SYSTEMATIC REVIEW

Introduction : Sedation and pain management are critical in pediatric intensive care units (PICU), ensuring patient comfort, minimizing distress, and preventing complications related to mechanical ventilation and prolonged hospitalization. Sedation protocols vary, incorporating opioids, benzodiazepines, dexmedetomidine, ketamine, and non-pharmacological methods. However, excessive sedation may lead to iatrogenic withdrawal syndrome (IWS), prolonged PICU stays, and adverse neurodevelopmental effects. This systematic review evaluates various sedation strategies, their efficacy, and associated risks in pediatric patients. Method : A systematic search was conducted using Google Scholar, PubMed, and ScienceDirect (2020–2025) with keywords (“sedation” OR “analgesia” OR “pain management”) AND (“pediatric intensive care” OR “PICU” OR “critically ill children”) AND (“opioids” OR “benzodiazepines” OR “dexmedetomidine” OR “propofol” OR “ketamine”). Studies were screened per PRISMA guidelines, with inclusion limited to RCTs, cohort, and observational studies. Literature reviews, case reports, and inaccessible articles were excluded. Discussion : The included studies highlight the varying efficacy of sedation techniques. Ketamine demonstrated reduced mechanical ventilation time and opioid dependence, while midazolam vs. propofol studies showed differing pain scores and recovery times. Continuous sedation led to longer PICU stays and sedation-related complications, reinforcing the need for structured sedation protocols. Non-pharmacological methods like music therapy effectively reduced pain scores and sedation dependency. Multimodal analgesia, combining opioids with regional anesthesia or adjuvant analgesics, optimized pain control while minimizing opioid use. Conclusion : Optimizing sedation in PICU requires a balanced multimodal approach integrating pharmacological and non-pharmacological methods. Minimizing opioid reliance, implementing sedation weaning protocols, and incorporating supportive therapies improve patient outcomes. Further long-term studies are needed to establish standardized sedation guidelines for critically ill pediatric patients.