Researchers investigate a new method of sedation for paediatric patients

Scientists at Children’s Health Research Institute (a program of Lawson Health Research Institute), Sunnybrook Research Institute and The Hospital for Sick Children (SickKids) are working together to study the potential benefits of inhaled sedation as an alternative to keep critically ill children sedated and comfortable.

“Many sick children need support from a ventilator and other life-saving treatments, and may require intravenous (IV) sedatives to tolerate these uncomfortable therapies,” says Dr. Rishi Ganesan, Lawson Associate Scientist and Paediatric Neurocritical Care Physician at Children’s Hospital at London Health Sciences Centre (LHSC). “However, our current sedation options may contribute to a complication called delirium. We are interested in evaluating if delirium and long-term neurological complications are lower in children receiving inhaled sedation compared to those receiving IV sedation, which is the current standard of care.”

Delirium is an acute change in mental state that children in critical care can sometimes develop as a result of their critical illness and the medications and therapies they receive during their hospital stay. Delirium presents as confusion, disorientation, agitation, excessive drowsiness or poor attention. Dr. Marat Slessarev, Lawson Scientist and Critical Care Physician at LHSC, has been researching and comparing inhaled sedation to IV sedation in adults since the pandemic hit in 2020 in a collaborative trial called SAVE-ICU with Dr. Angela Jerath, Anesthesiologist and Scientist at Sunnybrook.

“One of the challenges with IV sedation is that we do not have a way to measure the level of sedatives in the blood,” explains Dr. Slessarev. “Critically ill patients that are sedated can sometimes develop issues with the kidney and liver, which are both important in eliminating the sedatives from the blood stream.”

Through this novel collaborative research, the team is now looking at the potential benefits of inhaled sedation in paediatric patients.

“Inhaled sedatives are an alternative to currently used IV sedatives, and they may reduce delirium and accelerate brain recovery. Inhaled sedatives are used safely every day in operating rooms, widely available and inexpensive,” explains Dr. Jerath. “In contrast to IV sedatives, they do not accumulate in the body, are rapidly eliminated via the lungs, promote faster awakening and discharge from a ventilator, and reduce inflammation – which may be a contributing factor to delirium.”

Enrollment for the ABOVE trial is beginning at Children’s Hospital at LHSC and SickKids. The pilot study will enroll 60 critically ill paediatric patients who will be randomized into two groups; one group will receive inhaled sedation while the other will get standard IV sedation. Once the pilot phase of the trial is complete, the team hopes to expand this trial across the country with more paediatric intensive care units (ICUs) joining the larger trial.

“The field of critical care has made significant strides in life-saving technologies and therapies in recent years, but now we are focused on finding ways to ensure our patients continue to do well after leaving the hospital,” says Dr. Nicole McKinnon, Critical Care Physician and lead investigator at SickKids and a Scientist Track Investigator at SickKids Research Insitute. “This trial is a first step in better understanding the effects of sedative and pain medications on children’s longer-term neurocognitive development. Our research will be key to providing critically ill children with the greatest chance to flourish at home.”

“This has the potential to change how critically ill children are cared for in paediatric ICUs across Canada and the world,” adds Dr. Ganesan. “We hope that inhaled sedation makes a difference in children’s long-term functional outcomes, so they can thrive and achieve their full potential.”

The ABOVE Trial recently received funding through a Canadian Institute for Health Research (CIHR) grant.