Dexmedetomidine for Sedation During Pediatric Noninvasive Ventilation

Abstract

BACKGROUND: Noninvasive ventilation (NIV) facilitates management of acute respiratory failure without intubation. Many pediatric patients cannot tolerate the discomfort associated with noninvasive support and require sedation with agents that may decrease respiratory drive. Dexmedetomidine does not decrease respiratory drive, and we hypothesized that its use would increase tolerance of noninvasive respiratory support without increasing risk for intubation. METHODS: A retrospective chart review was performed of all subjects at least 3 months of age with acute respiratory failure requiring NIV who were admitted to the pediatric ICU at a children's hospital for a 3-y period from 2015-2018. Subjects were stratified to those receiving continuous dexmedetomidine versus those not receiving sedation. Medical history was reviewed for developmental delay (DD) or intellectual disability (ID) as well as basic demographic information. To control the association between these variables with both dexmedetomidine use and intubation, augmented inverse probability weighting was utilized to establish equivalent baselines between the dexmedetomidine and no-sedation groups. Primary outcome was intubation rate within 6 h of initiation of dexmedetomidine infusion or NIV. RESULTS: Based on the strong association between age and dexmedetomidine use, a statistical model including subjects > age 5 was not able to be generated, and these subjects were excluded from final analysis. One-hundred eight subjects were included in the final statistical analysis, with 60 receiving dexmedetomidine and 48 receiving no sedation. Dexmedetomidine was effective at reducing agitation, with no difference noted in intubation rate at 6 h between subjects receiving dexmedetomidine versus no sedation (13.1 vs 12.4%). CONCLUSIONS: Dexmedetomidine may allow tolerance of NIV in acute respiratory failure without increasing risk for intubation, especially in preschool age patients and those with DD or ID. A larger study involving multiple centers would help support our conclusions.

A Novel Scale to Assess Humidification during Noninvasive Ventilation: A Prospective Observational Study

“…Adequate humidifcation is important for patients during NIV intervention. It can reduce NIV-induced airway dryness, promote the transportation of secretions from the lungs, increase the tolerance of NIV, and improve patient comfort [16,17]. However, inadequate humidifcation is not uncommon, even when heated humidifcation is used.…”

Dexmedetomidine: A Means to an End or Just Delaying the Inevitable?

“…Eidman et al 25 should be applauded for sharing their experience, even in light of the multiple limitations in this report. Despite a power analysis, the study was significantly underpowered to detect differences in outcomes as they almost certainly overestimated the potential effect of dexmedetomidine on intubation rate.…”

Dexmedetomidine in Children on Extracorporeal Membrane Oxygenation: Pharmacokinetic Data Exploration Using Previously Published Models

“…It has become a commonly used sedative in pediatric critical care settings ( 1 ). Contrary to other sedatives, it does not affect the respiratory drive and, therefore, is particularly appealing in children supported by non-invasive ventilation or to facilitate extubation ( 2 , 3 ). It has also been associated with reduced delirium and withdrawal ( 4 ).…”