Prolonged dexmedetomidine infusions in critically ill infants and children

Abstract

Objective: To present our institutional experience with prolonged dexmedetomidine (DEX) infusions in critically ill infants and children.

Design: Retrospective medical chart review between January 1, 2007 and December 1, 2007.

Setting: Tertiary care pediatric teaching hospital.

Participants: Infants and children (up to 18 years of age) who received DEX for a duration greater than 24 hours.

Main outcome measures: DEX dosing schema and rationale for use. Indices describing DEX efficacy and tolerability including change in patient-specific sedation scores, change in blood pressure and heart rate, and change in conventional analgesia and sedation requirements.

Results: Twenty-nine patients (age 5.32 +/- 6.1 y) were evaluated. DEX therapy was initiated at 0.36 +/- 0.16 mcg/kg/hour. One-third of patients received a loading dose (0.5-1 mcg/kg) prior to the start of the infusion. Duration of DEX therapy was 110 +/- 83 hours (range 32-378 hours; median 76 hours). Rationale for adding DEX to sedation regimens included: intent to extubate (n=12), intent to reduce benzodiazepine and opioid use (n=10), exclusive continuous sedation (n=5) and management of drug withdrawal (n=2). Sedation scores remained stable during DEX therapy. Use of conventional analgesia and sedation was generally reduced while receiving DEX. Initiation of therapy was associated with a transient, yet statistically significant reduction in HR (from 120 +/- 28 bpm to 107 +/-N 27 bpm) (P = 0.002), but without a change in blood pressure.

Conclusions: Prolonged DEX infusions were associated with a reduction in concomitant analgesia and sedation medications. DEX was well tolerated with the exception of heart rate, which decreased during the initiation of therapy but may not represent a clinically significant reduction.