{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T07:02:20Z","timestamp":1779951740885,"version":"3.53.1"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>When standard intravenous regimens fail, children in the pediatric intensive care unit often face escalating sedative polypharmacy with potential harm; we therefore evaluated inhaled isoflurane as a rescue sedation strategy in mechanically ventilated children with failure of a conventional sedation regimen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center retrospective observational study (2017\u20132020) in a 10-bed tertiary mixed pediatric intensive care unit (medical, neurologic, cardiac and traumatic conditions), isoflurane was delivered via an anesthetic conserving device while concomitant intravenous sedatives were down-titrated to sedation targets assessed by the COMFORT-B score, and cardiovascular support was quantified using the vasoactive-inotropic score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-one children were analyzed (median age 3.0 years; median Pediatric Index of Mortality 3 score 15.9%); isoflurane was initiated after a median of 3 days of prior sedation and continued for a median of 8 days; the median number of sedative agents decreased from 4 to 3 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), doses of clonidine, sufentanil, and propofol were significantly reduced, and rescue medication use for breakthrough agitation declined from 100% to 42.9% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), while vasoactive-inotropic score increased from 6.22 to 9.70 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008); five patients died, and among survivors delirium (87.5%) and withdrawal (44%) were frequent, with most extubated within 24\u2005h after isoflurane cessation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Isoflurane can meaningfully reduce sedative burden and agitation-related rescue interventions in difficult-to-sedate children, but the observed increase in vasoactive support and frequent delirium\/withdrawal after prolonged use underscore the need for vigilant hemodynamic monitoring and structured down-titration\u2014key considerations for centers contemplating volatile-based rescue sedation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1810790","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T06:15:35Z","timestamp":1779948935000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Isoflurane for difficult sedation in critically ill children: a retrospective analysis in a mixed pediatric intensive care population"],"prefix":"10.3389","volume":"14","author":[{"given":"Richard","family":"Biedermann","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division for Neonatology and Pediatric Intensive Care, University Hospital Jena, Friedrich Schiller University Jena","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Koeplin","sequence":"additional","affiliation":[{"name":"Medical Faculty, Friedrich Schiller University Jena","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Doerfel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division for Neonatology and Pediatric Intensive Care, University Hospital Jena, Friedrich Schiller University Jena","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natja","family":"Liebers","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division for Neonatology and Pediatric Intensive Care, University Hospital Jena, Friedrich Schiller University Jena","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Newman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division for Neuropediatrics, University Hospital Jena, Friedrich Schiller University Jena","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Proquitt\u00e9","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division for Neonatology and Pediatric Intensive Care, University Hospital Jena, Friedrich Schiller University Jena","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1007\/s00134-016-4344-1","article-title":"Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals","volume":"42","author":"Harris","year":"2016","journal-title":"Intensive Care Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1097\/PCC.0000000000001737","article-title":"Management of pediatric severe traumatic brain 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