title: Optimal sedation in pediatric intensive care patients: a systematic review.
abstract: OBJECTIVE
  Sedatives administered to critically ill children should be titrated to effect, because both under- and oversedation may have negative effects. We conducted a systematic review to examine reported incidences of under-, optimal, and oversedation in critically ill children receiving intensive care.
  
  
  METHODS
  A systematic literature search using predefined criteria was performed in PubMed and Embase to identify all articles evaluating level of sedation in PICU patients receiving continuous sedation. Two authors independently recorded: study objective, study design, sample size, age range, details of study intervention (if applicable), sedatives used, length of sedation, sedation scale used, and incidences of optimal, under-, and oversedation as defined in the studies.
  
  
  RESULTS
  Twenty-five studies were included. Two studies evaluated sedation level as primary study outcome; the other 23 as secondary outcomes. Together, these studies investigated 1,163 children; age range, 0-18 years. Across studies, children received many different sedative agents and sedation level was assessed with 12 different sedation scales. Optimal sedation was ascertained in 57.6 % of the observations, under sedation in 10.6 %, and oversedation in 31.8 %.
  
  
  CONCLUSIONS
  This study suggests that sedation in the PICU is often suboptimal and seldom systematically evaluated. Oversedation is more common than undersedation. As oversedation may lead to longer hospitalization, tolerance, and withdrawal, preventing oversedation in pediatric intensive care deserves greater attention.
authors.affiliation: Intensive Care, Erasmus MC, Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands. n.vet@erasmusmc.nl
authors.forename: Nienke J
authors.initials: NJ
authors.lastname: Vet
authors.forename: Erwin
authors.initials: E
authors.lastname: Ista
authors.forename: Saskia N
authors.initials: SN
authors.lastname: de Wildt
authors.forename: Monique
authors.initials: M
authors.lastname: van Dijk
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Matthijs
authors.initials: M
authors.lastname: de Hoog
mesh_terms: D002648:Child; D016292:Procedural Sedation / Q000592:standards*; D003422:Critical Care / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives
chemical_list: D006993:Hypnotics and Sedatives