Advancing Brain Outcomes in Pediatric Critically Ill Patients Sedated With Volatile AnEsthestic Agents

This study — called ABOVE (Advancing Brain Outcomes) — investigates whether using volatile anesthetic gases (like isoflurane or sevoflurane, the type used in operating rooms) for sedation in critically ill children on ventilators leads to better brain outcomes than standard intravenous (IV) sedation. Children in pediatric intensive care often need sedation for days while on a breathing machine, and the drugs used can profoundly affect brain development and recovery. Volatile anesthetics may offer advantages in terms of shorter sedation duration and potentially less delirium. The trial enrolls pediatric patients from 1 month to under 18 years old who need sedation for mechanical ventilation expected to last at least 24 hours. Children with certain genetic muscle diseases (like Duchenne muscular dystrophy), a family or personal history of malignant hyperthermia, known allergy to volatile anesthetics, high intracranial pressure, or who are expected to survive less than 24 hours are excluded. This research matters enormously because PICU-associated brain injury — including delirium, developmental delay, and cognitive problems after discharge — affects thousands of children each year. Finding the safest, most brain-protective sedation method could significantly improve outcomes for some of the most vulnerable pediatric patients.