Grant: Operating Grant: Clinical Trials Projects

In children needing life-saving critical care, over 50% suffer from an acute brain disorder called delirium which presents as poor concentration, memory and attention. Unfortunately, delirium has no treatment and leads to higher risk of childhood death, longer hospital stays and higher costs of care. For families, their child is irritable, may not recognize them when they visit, and can lead to longer-term care burdens as delirium has been linked to slower and impaired childhood brain and behaviour development after hospital discharge. Many sick children need support from a breathing machine (ventilator) which requires intravenous sedatives to tolerate this uncomfortable procedure. Unfortunately, our current sedatives may contribute to delirium. Inhaled sedatives are an alternative to currently used intravenous sedatives, and they may reduce delirium and accelerate brain recovery. Inhaled sedatives are used safely every day in operating rooms, widely available and cheap. In contrast to intravenous sedatives, they do not accumulate in the body, are rapidly eliminated via the lungs, promote faster awakening and liberation from the ventilator, and reduce inflammation, which may reduce delirium. Our objective is to evaluate the feasibility of using sedation with inhaled anesthetics in critically ill children, assess its safety and provide early information on delirium compared to intravenous sedatives. We will follow children who survive their hospital stay for 1-year to study any differences in intellectual and behaviour development. The information gathered will be used to conduct a larger study to see if inhaled anesthetics provide better sedation in critically ill children and reduce delirium. This study is unique for North America and will introduce a new type of sedation care for sick children. Delirium is a universal problem, and our findings will be useful for promoting cognitive vitality of critically ill children worldwide.