Dexmedetomidine Use in a Pediatric Intensive Care Unit: A Retrospective Cohort Study.

Abstract

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. To describe the use and tolerability of dexmedetomidine in a large cohort of critically ill children. 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. 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. 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.