Abstract
BackgroundNoninvasive ventilation (NIV) is increasingly utilized in infants and young children, though associated with high failure rates due to agitation and poor compliance, mostly if patient-ventilator synchronization is required.MethodsA retrospective cohort study was carried out in an academic pediatric intensive care unit (PICU). Dexmedetomidine (DEX) was infused as unique sedative in 40 consecutive pediatric patients (median age 16 months) previously showing intolerance and agitation during NIV application.ResultsDuring NIV clinical application both COMFORT-B Score and Richmond Agitation-Sedation Scale (RASS) were serially evaluated. Four patients experiencing NIV failure, all due to pulmonary condition worsening, required intubation and invasive ventilation. 36 patients were successfully weaned from NIV under DEX sedation and discharged from PICU. All patients survived until home discharge.ConclusionOur data suggest that DEX may represent an effective sedative agent in infants and children showing agitation during NIV. Early use of DEX in infants/children receiving NIV for acute respiratory failure (ARF) should be considered safe and capable of improving NIV, thus permitting both lung recruitment and patient-ventilator synchronization.
Highlights
Noninvasive ventilation (NIV) is increasingly utilized in infants and young children, though associated with high failure rates due to agitation and poor compliance, mostly if patient-ventilator synchronization is required
We describe our experience with DEX as a single sedative agent during NIV in pediatric patients
All patients were hypoxemic at NIV beginning, with a median P/F ratio of 175 (IQR 150;203)
Summary
Noninvasive ventilation (NIV) is increasingly utilized in infants and young children, though associated with high failure rates due to agitation and poor compliance, mostly if patient-ventilator synchronization is required. Noninvasive ventilation (NIV) has been reported as effective for treatment of respiratory failure associated with different respiratory diseases in childhood [1, 2]. Despite in adults data suggesting that the use of sedatives or opioids may improve patient comfort and Dexmedetomidine (DEX) is an α2-adrenergic agonist with a unique mechanism of action, providing sedation and anxiolysis via receptors within the locus coeruleus, analgesia via receptors in the spinal cord, and attenuation of stress response with no significant respiratory depression; several studies have demonstrated short length of weaning [8,9,10,11]; DEX has been recently proposed to manage NIV failure due to interface intolerance in adult patient with acute respiratory failure (ARF)
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