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Age-Related Differences in Benzodiazepine Dosing for Mechanically Ventilated Pediatric ICU Patients: A Retrospective

Amanda R Kolmar1, Daniela Bravo1, Ricardo A Fonseca2

  • 1Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St. Louis, Missouri, USA.

Journal of Intensive Care Medicine
|March 17, 2026
PubMed

Insights

Younger children, particularly infants and preschoolers, require higher doses of benzodiazepines for mechanical ventilation compared to older children. This highlights a need to investigate sedative dosing variations in pediatric intensive care units (ICUs).

Area of Science:

  • Pediatric critical care medicine
  • Pharmacology
  • Neuroscience

Background:

  • Benzodiazepines are commonly used for sedation in pediatric intensive care units (ICUs) to facilitate mechanical ventilation.
  • Understanding age-related differences in benzodiazepine dosing is crucial for optimizing patient care and minimizing adverse effects.

Purpose of the Study:

  • To determine if benzodiazepine (midazolam and lorazepam) dose intensity differs among pediatric age cohorts requiring mechanical ventilation.
  • To test the hypothesis that younger children receive higher benzodiazepine doses.

Main Methods:

  • A retrospective cohort study was conducted on mechanically ventilated pediatric ICU patients receiving benzodiazepines.
  • Dose intensity (mg/kg/day) of midazolam and lorazepam was calculated and compared across age groups.
  • Statistical analysis involved linear mixed-effects models and multivariable regression, with Tukey-adjusted pairwise comparisons.

Main Results:

  • Infants and preschool-aged children received significantly higher midazolam dose intensity compared to older children.
  • Infants also received higher lorazepam dose intensity than elementary-aged and older children.
  • These findings remained significant after adjusting for illness severity and ventilation indication.

Conclusions:

  • Children under five years old, especially infants and preschoolers, are prescribed higher benzodiazepine dose intensities for mechanical ventilation tolerance.
  • The study suggests further research into variations in sedative dosing, pharmacogenomics, and clinical outcomes in pediatric populations is warranted due to potential negative impacts on developing brains.

Keywords:
ICU outcomesmechanical ventilationpediatric intensive caresedation

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