The use of dexmedetomidine in critically ill children

Objective: To describe the use of dexmedetomidine for sedating intubated children in a general medical/surgical pediatric intensive care unit (PICU). Design: Retrospective, observational study. Setting: Multidisciplinary PICU of a tertiary, university-affiliated children's hospital. Patients: All children receiving dexmedetomidine within the PICU during the period of August 2003 to August 2005. Interventions: None. Measurements and Main Results: During the study period, 121 mechanically ventilated patients, median age 36 months (range 2 months to 21 years), who received dexmedetomidine infusions. The infusion was initiated and adjusted per our PICU protocol. The average dose was 0.55 mu g/kg/hr (range 0.15-0.70 mu g/kg/hr) and average length of use was 25.8 hours (range 20 minutes to 60 hours). During the dexmedetomidine infusion, the mean decrease in total benzodiazepine and opiate dose as compared with the 24 hours prior was 42% and 36%, respectively. Most patients were able to reduce their benzodiazepine and opiate dose by at least 20% with the dexmedetomidine infusion (70% and 73% of patients, respectively). After discontinuing dexmedetomidine, the average change in total benzodiazepine and opiate dose as compared with the 24 hours before infusion was an increase of 14% and 1.5%, respectively. Fewer patients were able to maintain at least a 20% reduction in benzodiazepine and opiate after cessation of dexmedetomidine compared with the 24 hours before initiation (38% and 40% of patients, respectively). Hypotension and/or bradycardia requiring clinical intervention occurred in 33 of 121 (27%) patients. Discontinuation secondary to clinical concern was necessary in 12 of 121 (10%) patients. Conclusions. Our study suggests that many, although not all, mechanically ventilated children may be able to reduce their need for other sedation medications with the use of dexmedetomidine. However, the potential side effects of dexmedetomidine necessitates close hemodynamic monitoring with its use. (Pediatr Crit Care Med 2009; 10:381-386)