Dexmedetomidine Use in Critically Ill Children With Acute Respiratory Failure
Mary Jo C Grant, James B Schneider, Lisa A Asaro, Brenda L Dodson, Brent A Hall, Shari L Simone, Allison S Cowl, Michele M Munkwitz, David Wypij, Martha A Q Curley, Randomized Evaluation of Sedation Titration for Respiratory Failure Study Investigators, Martha A Q Curley, David Wypij, Geoffrey L Allen, Derek C Angus, Lisa A Asaro, Judy A Ascenzi, Scot T Bateman, Santiago Borasino, Cindy Darnell Bowens, G Kris Bysani, Ira M Cheifetz, Allison S Cowl, Brenda L Dodson, E Vincent S Faustino, Lori D Fineman, Heidi R Flori, Linda S Franck, Rainer G Gedeit, Mary Jo C Grant, Andrea L Harabin, Catherine Haskins-Kiefer, James H Hertzog, Larissa Hutchins, Aileen L Kirby, Ruth M Lebet, Michael A Matthay, Gwenn E McLaughlin, JoAnne E Natale, Phineas P Oren, Nagendra Polavarapu, James B Schneider, Adam J Schwarz, Thomas P Shanley, Shari Simone, Lewis P Singer, Lauren R Sorce, Edward J Truemper, Michele A Vander Heyden, R Scott Watson, Claire R Wells, Mary Jo C Grant, James B Schneider, Lisa A Asaro, Brenda L Dodson, Brent A Hall, Shari L Simone, Allison S Cowl, Michele M Munkwitz, David Wypij, Martha A Q Curley, Randomized Evaluation of Sedation Titration for Respiratory Failure Study Investigators, Martha A Q Curley, David Wypij, Geoffrey L Allen, Derek C Angus, Lisa A Asaro, Judy A Ascenzi, Scot T Bateman, Santiago Borasino, Cindy Darnell Bowens, G Kris Bysani, Ira M Cheifetz, Allison S Cowl, Brenda L Dodson, E Vincent S Faustino, Lori D Fineman, Heidi R Flori, Linda S Franck, Rainer G Gedeit, Mary Jo C Grant, Andrea L Harabin, Catherine Haskins-Kiefer, James H Hertzog, Larissa Hutchins, Aileen L Kirby, Ruth M Lebet, Michael A Matthay, Gwenn E McLaughlin, JoAnne E Natale, Phineas P Oren, Nagendra Polavarapu, James B Schneider, Adam J Schwarz, Thomas P Shanley, Shari Simone, Lewis P Singer, Lauren R Sorce, Edward J Truemper, Michele A Vander Heyden, R Scott Watson, Claire R Wells
Abstract
Objective: Care of critically ill children includes sedation but current therapies are suboptimal. To describe dexmedetomidine use in children supported on mechanical ventilation for acute respiratory failure.
Design: Secondary analysis of data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial.
Setting: Thirty-one PICUs.
Patients: Data from 2,449 children; 2 weeks to 17 years old.
Interventions: Sedation practices were unrestrained in the usual care arm. Patients were categorized as receiving dexmedetomidine as a primary sedative, secondary sedative, periextubation agent, or never prescribed. Dexmedetomidine exposure and sedation and clinical profiles are described.
Measurements and main results: Of 1,224 usual care patients, 596 (49%) received dexmedetomidine. Dexmedetomidine as a primary sedative patients (n = 138; 11%) were less critically ill (Pediatric Risk of Mortality III-12 score median, 6 [interquartile range, 3-11]) and when compared with all other cohorts, experienced more episodic agitation. In the intervention group, time in sedation target improved from 28% to 50% within 1 day of initiating dexmedetomidine as a primary sedative. Dexmedetomidine as a secondary sedative usual care patients (n = 280; 23%) included more children with severe pediatric acute respiratory distress syndrome or organ failure. Dexmedetomidine as a secondary sedative patients experienced more inadequate pain (22% vs 11%) and sedation (31% vs 16%) events. Dexmedetomidine as a periextubation agent patients (n = 178; 15%) were those known to not tolerate an awake, intubated state and experienced a shorter ventilator weaning process (2.1 vs 2.3 d).
Conclusions: Our data support the use of dexmedetomidine as a primary agent in low criticality patients offering the benefit of rapid achievement of targeted sedation levels. Dexmedetomidine as a secondary agent does not appear to add benefit. The use of dexmedetomidine to facilitate extubation in children intolerant of an awake, intubated state may abbreviate ventilator weaning. These data support a broader armamentarium of pediatric critical care sedation.
Conflict of interest statement
No conflicts of interest.
Source: PubMed