Abstract / Summary
Abstract Managing pain, anxiety, and agitation in the pediatric intensive care unit (PICU) is often challenging. Pharmacological sedation and analgesia with opioids and benzodiazepines are essential components of PICU management. Although these are effective, they carry risks of adverse outcomes, including delirium, prolonged mechanical ventilation (MV), opioid tolerance, withdrawal syndrome, and poor neurodevelopmental outcomes. Recently, non-pharmacological interventions (NPIs) have shown promise to be used as an adjunct to multimodal sedation and analgesia strategies. In this narrative review, we synthesize available evidence regarding NPIs in reducing pain, agitation, and sedation requirements in critically ill children. NPIs, including environmental modifications, cognitive strategies, family-centered care, and sensory-based therapies, demonstrated a beneficial role in reducing procedural pain and anxiety, improving sedation levels, and decreasing sedative exposure. Distraction techniques (virtual reality, video) showed the most consistent evidence for reducing procedural pain, while delirium prevention bundles, including environmental interventions, improve sleep and reduce the incidence of delirium. However, heterogeneity in study design and outcome measures limits comparability. Non-pharmacological strategies can be used as adjuncts to pharmacologic sedation and analgesia in the PICU in integration with a multimodal “comfort bundle” approach. High-quality multicenter trials are required to standardize implementation and evaluate long-term outcomes.