Background Dexmedetomidine is a selective α2 agonist, and was approved by USFDA in 1999 to be used initially for sedation in adults who are intubated and mechanically ventilated. The manufacturer recommends the duration of infusion not to exceed 24 hours. There are limited data on its use in children.
Purpose The aim of this study was to describe the use of dexmedetomidine for sedation in the Paediatric Intensive Care Unit (PICU) with regard to the dose, duration of infusion, effect on heart rate (HR) and systolic blood pressure (SBP).
Material and methods The study was conducted at the PICU. We carried out a retrospective charts review for all children less than 14 years admitted between May 2014 and April 2015 who received dexmedetomidine. Demographic data, HR, SBP, starting and maximum dose, time and duration of infusion, and the concurrent use of midazolam were collected. IRB approval was obtained with a waiver of informed consent.
Results A total of 65 children with a median age of 24 (1 to 156) months, weight of 11 (2.3 to 90) kg. The reason for admission was 64.6% for medical indications and 35.4% for surgical indications. The starting dose was 0.48 mcg/kg/hr (0.25–1 mcg/kg/hr), and the maximum maintenance dose reached was 0.84 mcg/kg/hr (0.4–1.5 mcg/kg/hr). For the duration of infusion, the mean was 7.30 days (1–34 days), and two patients reached 60 and 63 days of dexmedetomidine infusion. There was no significant difference in the duration of infusion with respect to age group (p=0.082). There was a significant decrease in HR (p≤0.0001), baseline 114.23+22.08 bpm and post-infusion 105.49+21.65 bpm. No hypotensive episodes necessitating the discontinuation of infusion were reported (100.45+15.42 mm Hg). The majority of patients (55%) were able to be weaned off midazolam after starting dexmedetomidine infusion, while 43% were still on midazolam infusion and the dose range of midazolam was 1–6 mcg/kg/min.
Conclusion Using dexmedetomidine for sedation as a continuous infusion in the PICU seems to be relatively safe. A prospective randomised clinical trial is warranted to prove more safety and efficacy data on the use of dexmedetomidine infusion for intubated paediatric patients.
References and/or acknowledgements No conflict of interest.
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