Dr. Angela Jerath and Dr. Brian Cuthbertson receive funding from the CIHR

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 ventilator, which requires intravenous (IV) sedatives to tolerate this uncomfortable procedure. Unfortunately, current sedatives may contribute to delirium through a combination of pharmacological and patient factors.

Inhaled sedatives are an alternative to currently used IV sedatives, and they may reduce delirium and accelerate brain recovery. Inhaled sedatives are used safely every day in operating rooms, widely available and inexpensive. In contrast to IV 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.

The ABOVE trial aims 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 IV sedatives. The research team will follow children who survive their hospital stay for one 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 worldwide.