Related Experiment Video
Updated: Jan 12, 2026
11:19
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
18.3K
Pediatric Palliative Sedation Practices in the Intensive Care Unit
Amanda Mihalik1, Sean Gamble2, Amy Brown3
1Division of Palliative Medicine, Phoenix Children's, Phoenix, Arizona, USA.
Journal of Palliative Medicine
|October 31, 2025
Summary
Palliative sedation therapy (PST) in pediatric ICUs shows varied practices, with a need for more education and standardized guidelines. Opioids and benzodiazepines are common medications used in PST.
Area of Science:
- Pediatric intensive care
- Palliative care
- Medical ethics
Background:
- Palliative sedation therapy (PST) mitigates suffering in dying patients but is underutilized.
- Little is known about PST practices specifically within pediatric intensive care units (ICUs).
Purpose of the Study:
- To explore current PST practices in pediatric ICU settings.
- Identify common indications, medications, and provider comfort levels with PST.
Main Methods:
- Anonymous electronic survey distributed to pediatric pain, palliative, and ICU providers in the US.
- Descriptive analysis of 74 survey responses regarding PST protocols and implementation.
Main Results:
- Most respondents (62%) were early-career physicians; common ICUs were pediatric (34%), neonatal (30%), and cardiac (15%).
- Intractable pain (47%) and refractory respiratory distress (38%) were primary indications for PST.
- Opioids (78%) and benzodiazepines (63%) were frequently used medications; provider comfort averaged 6.4/10.
- Many lacked clear institutional guidelines (55%) or ethics involvement (86%) and were unsure about DNR order requirements (55%).
Conclusions:
- PST practices in pediatric ICUs are inconsistent.
- Increased education, standardized guidelines, and order sets are crucial for effective PST implementation.
Keywords:
early integrationend-of-lifeintensive care unitpalliative carepalliative sedationrefractory symptom managementMore Related Videos
09:36Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device
Published on: September 24, 2020
3.1K
06:04Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
9.2K
Related Concept Videos
01:24Parenteral Anesthetics: Overview
566
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
566
01:29Drug Dosing: Infants and Children
241
Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
241
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
201
In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
201
01:20Inhalational Anesthetics: Overview
970
Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
970
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
249
Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
249
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
239
Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
239