Effects of two dosing cohorts of dexmedetomidine as a primary sedative in critically ill infants with respiratory failure

Abstract

Background Despite being increasingly used, prospective randomized dose-finding studies on dexmedetomidine (DEX) sedation in infants are deficient. Aim The aim was to compare the efficacy of two fixed dosing cohorts of DEX as a primary sedative in the pediatric ICU. Patients and methods Thirty-seven pediatric ICU mechanically ventilated infants (1–12 months) with acute respiratory failure were randomly allocated to receive DEX infusion without a loading dose: 0.5 µg/kg/h (group I, intermediate dose, n=18) or 0.35 µg/kg/h (group II, low dose, n=19) up to 72 h. The primary outcome was University of Michigan Sedation Scale (UMSS). Secondary outcomes were supplemental sedation or analgesia, hemodynamics, withdrawal adverse effects, withdrawal assessment tool-version 1, and ICU and length of hospital stay. Results Duration of DEX infusion was (48.8±21.7 vs 37.8±21.3 h) in groups I and II (P=0.127). UMSS scores were significantly lower in group II. Supplemental sedation was needed in two patients in group II. Total ICU and hospital length of stay were 6.2±1.4 vs 3.6±1.9 days, P Conclusion Two doses produced adequate sedation with comparable opioid sparing. The low dose was associated with lower UMSS scores, more agitation following DEX discontinuation, and lower ICU and length of hospital stay.