Scientists at the Children’s Health Research Institute (a program of the Lawson Health Research Institute), Sunnybrook Research Institute, and The Hospital for Sick Children (SickKids) are collaborating to explore inhalation sedation as an alternative method to sedate and keep critically ill children comfortable. researching the potential benefits of .
“Many sick children require support from ventilators and other life-saving treatments, and may require intravenous (IV) sedation to help them endure these uncomfortable treatments,” says London Children’s Hospital. says Dr. Rishi Ganesan, Lawson Associate Scientist and Pediatric Neurocritical Care Physician. Health Sciences Center (LHSC). “However, our current sedation options can lead to a complication called delirium. We are interested in assessing whether delirium and long-term neurological complications are lower in children who are pregnant.”
Delirium is a sudden change in mental status that children receiving critical care sometimes develop as a result of a serious illness or the medications and treatments they receive during hospitalization. Delirium manifests as confusion, disorientation, agitation, excessive sleepiness, or decreased alertness. Dr. Marat Slesarev, a Lawson scientist and critical care physician at LHSC, has been researching and comparing collaborative trials of inhalation and IV sedation in adults since the pandemic began in 2020. Ta. Save ICU with Dr. Angela Jealous, an anesthesiologist and scientist at Sunnybrook University.
“One of the challenges with IV sedation is that there is no way to measure the level of sedative in the blood,” explains Dr. Slesarev. “Critically ill patients who are given sedatives can develop problems with their kidneys and liver, both of which are important in eliminating sedatives from the bloodstream.”
Through this new collaboration, the team is currently examining the potential benefits of inhalation sedation in pediatric patients.
“Inhaled sedatives are an alternative to currently used intravenous sedatives and may reduce delirium and promote brain recovery. Inhaled sedatives are used safely in the operating room every day and It is widely available and inexpensive,” explains Dr. Jealous. “In contrast to IV sedatives, sedatives do not accumulate in the body and are quickly eliminated through the lungs, promoting faster awakening and ventilator exit and reducing inflammation. This contributes to delirium. may be a contributing factor.”
Enrollment for the ABOVE trial is now open at LHSC Children’s Hospital and SickKids. This pilot study will enroll his 60 critically ill pediatric patients, who will be randomly divided into two groups. One group will receive inhalation sedation and the other group will receive standard IV sedation. Once the pilot phase of the trial is complete, the team hopes to expand the trial across the country by involving more pediatric intensive care units (ICUs) in the larger trial.
“The field of critical care has made great strides in life-saving techniques and treatments in recent years, but our focus now is on finding ways to help patients stay well after they are discharged from the hospital.” said Dr. Nicole McKinnon. Care Physician and Principal Investigator at SickKids and Scientist Track Investigator at SickKids Research Insitute. “This trial is a first step toward a deeper understanding of the effects of sedatives and analgesics on children’s long-term neurocognitive development. This will be the key to providing the greatest opportunity to
“This has the potential to change the way critically ill children are cared for in pediatric intensive care units in Canada and around the world,” Dr. Ganesan added. “We hope that inhalation sedation will make a difference in long-term functional outcomes for children, allowing them to thrive and reach their full potential.”
The ABOVE trial was recently funded through a Canadian Institutes of Health Research (CIHR) grant.
