1116

Abstract

Introduction: Critically ill children in the pediatric intensive care unit (PICU) often receive multiple classes of sedatives and analgesics for comfort and safety. Dexmedetomidine is frequently added when a child proves challenging to sedate with traditional opioid and benzodiazepine regimens. Discontinuation of prolonged infusions of high dose dexmedetomidine may result in a clinical withdrawal syndrome similar to opioid withdrawal, and clonidine is utilized to treat children experiencing withdrawal. Hypothesis: We hypothesize that longer duration and higher dose of dexmedetomidine is associated with clinical withdrawal syndrome and discharge home on transdermal or oral clonidine. Methods: We performed a retrospective chart review from June 2011 to June 2012 of all children who received dexmedetomidine for sedation in the pediatric intensive care unit. Dosing variables for dexmedetomidine, concurrent administration of other sedatives, and documentation of withdrawal with the Withdrawal Assessment Tool (WAT-1) were collected. Results: 37 children received dexmedetomidine during the 12-month period studied. The average daily dose of dexmedetomidine was 1.1 mcg/kg/hour and the mean duration of administration was 12.2 days. 10 children (27%) were discharged home on clonidine. The presence of greater than two concurrent sedatives at the time of dexmedetomidine initiation was predictive of longer dexmedetomidine duration and higher average daily dose. Longer duration of dexmedetomidine was associated with increased WAT scores within 24 hours of discontinuation and higher doses of clonidine upon discharge to home. After adjustment for age, sex and duration of intubation, dexmedetomidine dose and duration were not associated with survival to discharge. Conclusions: These data support the role of dexmedetomidine as a cause of physiologic withdrawal in critically ill children receiving sedatives. As dexmedetomidine use becomes more widespread in the critically ill pediatric population, further research is necessary to determine the physiologic effects of discontinuation of this drug after prolonged duration of therapy, and long-term outcomes in children discharged home on clonidine.