Critical Illness Clinical Trial
Official title:
New Approaches to Pediatric Sedation: Adjunctive Clonidine in the Sedation of Mechanically Ventilated Children (NAPS Pilot Trial)
Almost all critically ill children who are mechanically ventilated require sedation and analgesia. Providing effective sedation for children in the PICU requires careful balancing of the need for sedation with the adverse effects associated with sedative medications. Clonidine is often used as an adjunctive sedative and analgesic in children but a well designed and adequately powered randomized trial is required to test the effect of clonidine-based sedation. Because there are no large randomized trials of sedation related interventions among critically ill children there are many unknown factors. This pilot trial, focussing on feasibility outcomes will assess the feasibility of, and inform the design of, a larger randomized controlled trial which will focus on clinically important outcomes.
Almost all critically ill children who are mechanically ventilated require sedation and
analgesia. Providing effective sedation for children in the PICU requires careful balancing
of the need for sedation with the adverse effects associated with sedative medications.
Inadequate sedation may result in undue pain and suffering for children, ventilator
dysynchrony and may risk removal of life sustaining devices. Excess sedation limits patients'
interaction with their parents and care-givers and may result in delayed weaning from
mechanical ventilation, prolonged PICU stay and the attendant risks of increased morbidity.
Critically ill children may also experience withdrawal when these medications are stopped.
Randomized trails in adults have shown that sedation related interventions can improve
patients outcomes, but such trials have not been performed in children.
Clonidine is often used as an adjunctive sedative and analgesic in children but a well
designed and adequately powered randomized trial is required to test the effect of
clonidine-based sedation. Because there are no large randomized trials of sedation related
interventions among critically ill children there are many unknown factors.
This pilot trial, focussing on feasibility outcomes will assess the feasibility of, and
inform the design of, a larger randomized controlled trial which will focus on clinically
important outcomes.
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