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

Research output: Contribution to journalArticle

29 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1131-1141
Number of pages11
JournalPediatric Critical Care Medicine
Volume17
Issue number12
DOIs
StatePublished - Dec 1 2016

Fingerprint

Dexmedetomidine
Critical Illness
Respiratory Insufficiency
Hypnotics and Sedatives
Ventilator Weaning
Pediatrics
Patient Care
Adult Respiratory Distress Syndrome
Proxy
Critical Care
Artificial Respiration

Keywords

  • agitation
  • endotracheal intubation
  • extubation
  • pediatric intensive care
  • withdrawal

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Grant, M. J. C., Schneider, J. B., Asaro, L. A., Dodson, B. L., Hall, B. A., Simone, S. L., ... Curley, M. A. Q. (2016). Dexmedetomidine Use in Critically Ill Children with Acute Respiratory Failure. Pediatric Critical Care Medicine, 17(12), 1131-1141. https://doi.org/10.1097/PCC.0000000000000941

Dexmedetomidine Use in Critically Ill Children with Acute Respiratory Failure. / Grant, Mary Jo C; Schneider, James B.; Asaro, Lisa A.; Dodson, Brenda L.; Hall, Brent A.; Simone, Shari L.; Cowl, Allison S.; Munkwitz, Michele M; Wypij, David; Curley, Martha A Q.

In: Pediatric Critical Care Medicine, Vol. 17, No. 12, 01.12.2016, p. 1131-1141.

Research output: Contribution to journalArticle

Grant, MJC, Schneider, JB, Asaro, LA, Dodson, BL, Hall, BA, Simone, SL, Cowl, AS, Munkwitz, MM, Wypij, D & Curley, MAQ 2016, 'Dexmedetomidine Use in Critically Ill Children with Acute Respiratory Failure', Pediatric Critical Care Medicine, vol. 17, no. 12, pp. 1131-1141. https://doi.org/10.1097/PCC.0000000000000941
Grant MJC, Schneider JB, Asaro LA, Dodson BL, Hall BA, Simone SL et al. Dexmedetomidine Use in Critically Ill Children with Acute Respiratory Failure. Pediatric Critical Care Medicine. 2016 Dec 1;17(12):1131-1141. https://doi.org/10.1097/PCC.0000000000000941
Grant, Mary Jo C ; Schneider, James B. ; Asaro, Lisa A. ; Dodson, Brenda L. ; Hall, Brent A. ; Simone, Shari L. ; Cowl, Allison S. ; Munkwitz, Michele M ; Wypij, David ; Curley, Martha A Q. / Dexmedetomidine Use in Critically Ill Children with Acute Respiratory Failure. In: Pediatric Critical Care Medicine. 2016 ; Vol. 17, No. 12. pp. 1131-1141.
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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.",
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AU - Cowl, Allison S.

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N2 - 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.

AB - 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.

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