Paralyzation and sedation of the ventilated trauma patient.
Sedation and analgesia will be required in the mechanically ventilated pediatric trauma patient. Adequate provision of both has a number of beneficial physiologic and psychologic effects. There are a number of categories of sedatives available for use. To provide optimal management and avoid adverse sequellae, an understanding of the pharmacology of these agents should guide their use in this group of patients, who are likely to have variable pharmacokinetic responses and therapeutic goals. Neuromuscular blockade is warranted in only a select population of mechanically ventilated ICU patients. Given newer ventilator technology and modes, it is certainly possible to achieve patient-ventilator synchrony with the use of sedation alone. Neuromuscular blockade is associated with a number of possible adverse effects, including prolonged weakness or paresis, and prohibits ongoing clinical assessment. When the use of this therapy is deemed necessary, it is again essential to understand the pharmacodynamics and pharmacokinetics of the available agents to avoid potential complications.
Primak
L K
LK
Division of Pediatric Pharmacology and Critical Care, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
Lowrie
L
L
D000698:Analgesia / Q000592:standards* / Q000639:trends; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods*; D012680:Sensitivity and Specificity; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*