Neurologic System
With respect to the neurologic system, the goal is to optimize oxygen delivery and
minimize cerebral oxygen demands by decreasing cerebral metabolism. To do this,
the child should have adequate oxygenation, optimal sedation, neuromuscular
blockade, if necessary, maintenance of euthermia, and minimal stimulation. Oxygenation
will be further addressed in the following section on respiratory system. The child
who is critically ill and undergoing frightening and painful procedures should have
adequate analgesia and anxiolysis. If it is necessary to use neuromuscular blockade,
analgesia and anxiolysis become more imperative. The child’s level of sedation must
be assessed frequently, and there are several tools available to standardize assessment
of sedation and pain relief.23 In addition, as the patient’s condition warrants,
there should be a drug holiday instituted daily. A drug holiday consists of discontinuing
neuromuscular blockade until slight movement is noted, then it is restarted. Keeping
the room quiet, providing soft music, and providing a favorite soft blanket may help
with control of anxiety and cerebral metabolism. Control of fever with acetaminophen,
ibuprofen, and/or cooling devices can help control cerebral metabolism as well.