BACKGROUND: Use of dexmedetomidine in critically ill pediatric patients is increasing despite limited data on effects on mechanical ventilation times, use of other sedatives, adverse effects, and withdrawal. OBJECTIVES: To describe the use and tolerability of dexmedetomidine in a large cohort of critically ill children. METHODS: This was a retrospective cohort study of patients receiving dexmedetomidine in a pediatric intensive care unit. Ethical approval was granted by the local review board. Data on dexmedetomidine administration, ventilatory support, other sedatives, adverse effects, and withdrawal were collected. RESULTS: There were 219 patients included. Dexmedetomidine was a first-line sedative in 47.9% of patients; the median infusion duration was 27 hours. Of patients on other sedatives at dexmedetomidine initiation, 39.5% had a dose reduction in those sedatives by 24 hours. Use of dexmedetomidine in noninvasively ventilated patients was common (19.6%), as was use in patients on no ventilatory support (35.6%). Patients receiving no ventilatory support used dexmedetomidine for shorter durations ( P = 0.001) and were less likely to have received prior sedatives ( P < 0.001). Adverse effects occurred in 42% of patients and were associated with younger age ( P = 0.001) and longer dexmedetomidine duration ( P < 0.001). The majority of patients (65%) were weaned off dexmedetomidine, and 80% of patients had at least one sign of withdrawal. CONCLUSIONS: Our data suggest substantial use in noninvasively ventilated patients. Adverse effects appeared more common in younger patients and those with prolonged infusions. A high rate of withdrawal effects was seen; no associations with age, dose, or duration were found.
BACKGROUND: Use of dexmedetomidine in critically ill pediatric patients is increasing despite limited data on effects on mechanical ventilation times, use of other sedatives, adverse effects, and withdrawal. OBJECTIVES: To describe the use and tolerability of dexmedetomidine in a large cohort of critically ill children. METHODS: This was a retrospective cohort study of patients receiving dexmedetomidine in a pediatric intensive care unit. Ethical approval was granted by the local review board. Data on dexmedetomidine administration, ventilatory support, other sedatives, adverse effects, and withdrawal were collected. RESULTS: There were 219 patients included. Dexmedetomidine was a first-line sedative in 47.9% of patients; the median infusion duration was 27 hours. Of patients on other sedatives at dexmedetomidine initiation, 39.5% had a dose reduction in those sedatives by 24 hours. Use of dexmedetomidine in noninvasively ventilated patients was common (19.6%), as was use in patients on no ventilatory support (35.6%). Patients receiving no ventilatory support used dexmedetomidine for shorter durations ( P = 0.001) and were less likely to have received prior sedatives ( P < 0.001). Adverse effects occurred in 42% of patients and were associated with younger age ( P = 0.001) and longer dexmedetomidine duration ( P < 0.001). The majority of patients (65%) were weaned off dexmedetomidine, and 80% of patients had at least one sign of withdrawal. CONCLUSIONS: Our data suggest substantial use in noninvasively ventilated patients. Adverse effects appeared more common in younger patients and those with prolonged infusions. A high rate of withdrawal effects was seen; no associations with age, dose, or duration were found.
Entities:
Keywords:
children; critical care; dexmedetomidine; intensive care unit; pediatric; sedation
Authors: Joanna L Stollings; Jennifer L Thompson; Benjamin A Ferrell; Mika Scheinin; Grant R Wilkinson; Christopher G Hughes; Ayumi K Shintani; E Wesley Ely; Timothy D Girard; Pratik P Pandharipande; Mayur B Patel Journal: Ann Pharmacother Date: 2018-01-24 Impact factor: 3.154
Authors: Erin R Beitz; Robert Seabury; Christopher D Miller; William Q Darko; Luke A Probst; Kelly E Steidl Journal: J Pediatr Pharmacol Ther Date: 2019 Nov-Dec
Authors: Jun Chen; Richard Perez; Angelo Mario de Mattos; Cecilia Wang; Zhongmin Li; Richard L Applegate; Hong Liu Journal: Clin Transl Sci Date: 2020-06-16 Impact factor: 4.689