Peer-reviewed article
Non-pharmacological analgesia and sedation in the pediatric intensive care unit: a narrative review
Amit Agrawal, Dalwinder Janjua, Roshan Chanchlani ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This narrative review looks at non-drug approaches to easing pain, anxiety and agitation in children in pediatric intensive care units. Drug sedation and pain relief are necessary but can cause problems such as delirium, longer time on a ventilator, opioid tolerance, withdrawal and poorer neurodevelopment. The authors report that non-drug approaches helped reduce procedural pain and anxiety, improve sedation levels and lower the amount of sedative used. They suggest using these approaches alongside medicines as part of a multimodal 'comfort bundle'. They note that the studies differ too much in design and outcome measures to be compared easily.
Key points
- Sedatives and opioids are effective but carry risks, including delirium, prolonged mechanical ventilation, opioid tolerance, withdrawal syndrome and poor neurodevelopmental outcomes.
- Non-drug approaches include environmental changes, cognitive strategies, family-centered care and sensory-based therapies.
- Distraction techniques such as virtual reality and video had the most consistent evidence for reducing procedural pain.
- Delirium prevention bundles that include environmental measures improve sleep and reduce the incidence of delirium.
- High-quality multicenter trials are needed to standardize implementation and evaluate long-term outcomes.
Limitations
Only the abstract is available, so it gives no numbers, study counts, ages or settings, and does not name the countries covered. The authors say differences in study design and outcome measures limit comparability, and long-term outcomes are not yet known.
Abstract
Abstract Managing pain, anxiety, and agitation in the pediatric intensive care unit (PICU) is often challenging. Pharmacological sedation and analgesia with opioids and benzodiazepines are essential components of PICU management. Although these are effective, they carry risks of adverse outcomes, including delirium, prolonged mechanical ventilation (MV), opioid tolerance, withdrawal syndrome, and poor neurodevelopmental outcomes. Recently, non-pharmacological interventions (NPIs) have shown promise to be used as an adjunct to multimodal sedation and analgesia strategies. In this narrative review, we synthesize available evidence regarding NPIs in reducing pain, agitation, and sedation requirements in critically ill children. NPIs, including environmental modifications, cognitive strategies, family-centered care, and sensory-based therapies, demonstrated a beneficial role in reducing procedural pain and anxiety, improving sedation levels, and decreasing sedative exposure. Distraction techniques (virtual reality, video) showed the most consistent evidence for reducing procedural pain, while delirium prevention bundles, including environmental interventions, improve sleep and reduce the incidence of delirium. However, heterogeneity in study design and outcome measures limits comparability. Non-pharmacological strategies can be used as adjuncts to pharmacologic sedation and analgesia in the PICU in integration with a multimodal “comfort bundle” approach. High-quality multicenter trials are required to standardize implementation and evaluate long-term outcomes.