Dexmedetomidine and Iatrogenic Withdrawal Syndrome in Critically Ill Children

Abstract

Background Iatrogenic withdrawal syndrome is a well-known adverse effect of sedatives and analgesics commonly used in patients receiving mechanical ventilation in the pediatric intensive care unit, with an incidence of up to 64.6%. When standard sedative and analgesic treatment is inadequate, dexmedetomidine may be added. The effect of supplemental dexmedetomidine on iatrogenic withdrawal syndrome is unclear. Objective To explore the potentially preventive effect of dexmedetomidine, used as a supplement to standard morphine and midazolam regimens, on the development of iatrogenic withdrawal syndrome in patients receiving mechanical ventilation in the pediatric intensive care unit. Methods This retrospective observational study used data from patients on a 10-bed general pediatric intensive care unit. Iatrogenic withdrawal syndrome was measured using the Sophia Observation withdrawal Symptoms-scale. Results In a sample of 102 patients, the cumulative dose of dexmedetomidine had no preventive effect on the development of iatrogenic withdrawal syndrome (P = .19). After correction for the imbalance in the baseline characteristics between patients who did and did not receive dexmedetomidine, the cumulative dose of midazolam was found to be a significant risk factor for iatrogenic withdrawal syndrome (P < .03). Conclusion In this study, supplemental dexmedetomidine had no preventive effect on iatrogenic withdrawal syndrome in patients receiving sedative treatment in the pediatric intensive care unit. The cumulative dose of midazolam was a significant risk factor for iatrogenic withdrawal syndrome.

Strategies for the management and prevention of withdrawal syndrome in critically ill pediatric patients: a systematic review

“…Of the 12 selected studies, four were RCTs; ( 19 - 22 ) three were NRCTs; ( 8 , 23 , 24 ) and five were observational studies. ( 25 - 29 ) All studies were conducted in pediatric ICUs. The country that conducted the most research on the subject was the United States with four.…”

“… 27 ) one dealt with the use of dexmedetomidine, ( 28 ) and the other four addressed the use of polytherapies with benzodiazepines and opiates. ( 20 , 21 , 25 , 26 )…”

“…The most commonly used scale in this category for the evaluation of withdrawal syndrome was the SOS, which was present in three of the seven studies. ( 20 , 25 , 27 ) To assess sedation, the Comfort scale was the most often used (in three of the studies), ( 20 , 21 , 25 ) followed by the Comfort-Behavior (Comfort-B), evaluated in two studies. ( 26 .…”

“…According to the findings of this study, protocols and drugs for the management and prevention of withdrawal syndrome did not significantly affect its incidence, and only three studies showed a statistically significant difference. ( 25 , 26 , 29 ) This fact could be attributed to the use of inadequate instruments for the study population in addition to the fact that they were not validated or translated into the language in question.…”