Evidence-Based Use of α-2 Agonists for Sedation in the PICU: From Fiction to Facts?

Adequate sedation and optimal pain relief are important goals to reach in every child admitted to a PICU. The ultimate goal is to achieve, with the minimal amount of medications possible, a situation where the child is having optimal comfort, pain control, and safety. Opioids and benzodiazepines have always been the mainstay of treatment to reach these aforementioned goals, but many times, adjunctive or alternative treatments are considered and used in the PICU to reach these goals. Clonidine and dexmedetomidine (α-2 agonists) are two of the most frequently used drugs to support the optimal use of opioids and/or benzodiazepines. Despite their frequent use in critically ill infants and children in PICUs across the globe, their real additive value is not yet established.
A very recent Cochrane review in adults showed that dexmedetomidine reduced the duration of mechanical ventilation and intensive care stay when compared with standard sedation regimens.
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