Abstract P-480: α2 AGONISTS IN PAEDIATRIC CRITICAL CARE SEDATION: A MULTI-SITE RETROSPECTIVE COHORT STUDY

Abstract

Aims & Objectives: This study aimed to evaluate if an opioid based sedative regimen with an α2 agonist adjunct (clonidine or dexmedetomidine) produces a non-inferior proportion of time at target sedation compared to a control group with an α2 agonist, while conferring additional benefits such as reduced opioid and benzodiazepine co-administration. Methods A retrospective cohort study at two Irish PICUs of first admission mechanically ventilated children receiving an opioid infusion between January 2014 and June 2016 was conducted. Children were categorised into an α2 agonist group or a control group. Using recorded COMFORT Behaviour Scale (CS) scores a proportion of time at target sedation (CS 11–16) for each included patient while mechanically ventilated was calculated alongside extraction of opioid and benzodiazepine use and clinical characteristics. A propensity score model was constructed to evaluate treatment effects including all identified relevant confounders. The pre-defined non-inferiority threshold for the primary outcome was set at 12.5%. Results One thousand and sixty-six admissions were included (685 clonidine,43 dexmedetomidine and 338 control). The α2 agonist based regimen produced a non-inferior time at optimal sedation +4.2% (95% CI -2.4 to 10.9%) though total morphine use was not statistically decreased at -1.74 µg/kg/hr (95% CI -4.83 to 1.34 µg/kg/hr) versus control. Benzodiazepine use was also not decreased. Conclusions A sedation regimen with an α2 agonist adjunct produces a non-inferior time at target sedation to a control group. However, no associated opioid or benzodiazepine sparing effects were observed in initial analysis to justify their inclusion in the sedative regimen