Objective:

To synthesize literature on the associations between sedation practices in pediatric intensive care units (PICUs) and subsequent neurocognitive outcomes, focusing on modifiable risk factors.

Approach:

• Literature Review: An iterative search strategy was employed, examining literature on neurocognitive outcomes following critical illness and sedation, prioritizing randomized controlled trials and large cohort studies.

Key Findings:

• Prolonged sedation in critically ill infants and children is linked to increased risk of neurocognitive impairments, as evidenced by various studies.
• Benzodiazepines are associated with higher rates of delirium and adverse cognitive outcomes, with specific studies indicating a significant correlation.
• Dexmedetomidine, an alpha-2 adrenergic agonist, may reduce the risk of delirium and has potential neuroprotective effects, although evidence is limited.

Interpretation:

The review emphasizes the significance of sedative choice on neurodevelopmental outcomes in pediatric patients following critical illness.

Limitations:

• Methodological variability and limited mechanistic insights hinder direct translation into clinical practice, as noted in the literature.
• Clinical data are often confounded by factors such as illness severity, comorbidities, and patient age.

Conclusion:

Modifiable factors in sedation practices can inform clinical approaches to improve neurocognitive outcomes in pediatric survivors of critical illness.