Adverse Cardiovascular and Systemic Effects of Sedative Infusions in Critically Ill Children

In pediatric critical care, the use of intravenous sedative infusions is a cornerstone of managing mechanically ventilated children. The 2022 Society of Critical Care Medicine (SCCM) guidelines recommend alpha-2 agonists, particularly dexmedetomidine, as primary sedation agents for this population, while other agents such as propofol, ketamine, and benzodiazepines remain in frequent use across diverse clinical scenarios.Despite the centrality of sedation in the pediatric intensive care unit (PICU), each sedative agent harbors distinct profiles of cardiovascular and systemic adverse effects that can profoundly impact patient outcomes—including bradycardia with alpha-2 agonists, the risk of the rare but life-threatening propofol infusion syndrome, hemodynamic instability and increased delirium risk with benzodiazepines (particularly in combination with opioids), and delirium associated with prolonged ketamine exposure. Although recent literature characterizes some of these risks, significant gaps persist in understanding their true incidence, underlying mechanisms, and the nuances of their manifestation in different pediatric subpopulations. There remains ongoing debate regarding the optimal balance between achieving effective sedation and minimizing adverse outcomes, as well as a need for more comprehensive studies to inform safer and more effective protocols. The field thus requires a sharper focus on individualized approaches and robust data to translate evolving evidence into better practice.This Research Topic aims to advance the understanding and mitigation of cardiovascular and systemic adverse effects arising from intravenous sedative infusions in critically ill children. Key objectives include identifying predictors and preventative measures for adverse events, evaluating strategies for safer and more personalized sedation protocols, and elucidating both immediate and long-term clinical consequences of sedative exposure in the PICU. We seek to clarify the risk-benefit profiles of commonly used agents and to explore the mechanisms by which oversedation and undersedation contribute to mortality, prolonged ventilation, and PICU readmission, alongside investigations of new or under-reported complications. Through this focused initiative, we endeavor to foster research that informs specific recommendations for risk stratification and outcome-based sedation management in pediatric critical care.This Research Topic is primarily limited to children aged 4–12 years requiring intravenous sedation in the PICU, though studies including other age ranges with clear clinical justification are welcomed. To gather further insights into these complex dynamics, we welcome articles addressing, but not limited to, the following themes:• Epidemiology and risk factors for cardiovascular and systemic adverse events associated with individual sedative agents• Mechanisms and prevention of propofol infusion syndrome and other rare, severe complications• Comparative effectiveness and safety profiles of different sedation regimens• Predictors of oversedation and undersedation and their impact on short- and long-term outcomes• Personalized sedation strategies, biomarkers, and risk stratification tools in pediatric critical care• Long-term sequelae of pediatric sedative exposure, including neurodevelopmental and psychological impacts• Implementation and evaluation of sedation protocols, bundles, and monitoring technologies Article types welcome include: Original research (including observational studies and randomized trials) and systematic reviews/meta-analyses are particularly encouraged; narrative reviews may be considered if they offer substantial new insights. Topic editors: Kiyan Heybati, Jiawen Deng Source: https://www.frontiersin.org/research-topics/78303/adverse-cardiovascular-and-systemic-effects-of-sedative-infusions-in-critically-ill-children