Use of Dexmedetomidine for Sedation in Critically Ill Mechanically Ventilated Pediatric Burn Patients

Abstract

Dexmedetomidine has previously been used only for short-term, procedural sedation in children. The purpose of this review was to describe the dosing, safety, and efficacy of dexmedetomidine for sustained sedation in intubated pediatric burn patients. The authors reviewed acutely burned children treated between 2005 and 2008 who were intubated during their course of care and who received dexmedetomidine for sedation. Patients served as their own controls using the time periods when they received sedatives other than dexmedetomidine. Eleven patients with 17 dexmedetomidine treatment courses were identified. The median patient age was 7 years (range 1.6-17 years), and median burn size was 30.5% TBSA (range 6-59%). Patients were ventilated for a median of 9 days (range 4-46 days). The median initial dose of dexmedetomidine was 0.39 μg/kg/hr (range 0.10-1.16 μg/kg/hr), with a median infusion dose of 0.57 μg/kg/hr (range 0.11-1.17 μg/kg/hr) and median treatment duration of 40 hours (range 1-356 hours). None of the patients received dexmedetomidine loading dose. Patients achieved more appropriate Riker scores while treated with dexmedetomidine than while being treated with other sedatives (3.8 vs 3.3, P = .003). The incidence of hypotension and/or bradycardia while on dexmedetomidine was not greater than when it was not being used. Clinically significant rebound hypertension and tachycardia were absent on discontinuation of dexmedetomidine. No unplanned extubations were observed. Median length of hospital stay was 49 days (range 7-118 days). Dexmedetomidine seems to be safe and effective for sedation of pediatric burn patients on mechanical ventilation with close cardiovascular monitoring.

Sedation and Pain Management in Burn Patients

“…For burn patients who develop extreme tolerance to morphine, clonidine, dexmedetomidine, ketamine and methadone have been found to be effective in the treatment of pain (Kariya 1998 Williams 1998). Dexmedetomidine has been used to provide sedation–analgesia for burned patients and to decrease opioid requirements (Walker 2006, Lin 2001). Titration of dexmedetomidine may also allow weaning of benzodiazepine as patients get close to extubation.…”

Acute and Perioperative Care of the Burn-injured Patient

“…100,101 Dexmedetomidine has been used to provide sedation–analgesia for burned patients and to decrease opioid requirements. 101–103 …”

Long QT Syndrome Unmasked by Dexmedetomidine: A Case Report

“…Dexmedetomidine is an alpha‐2 adrenergic agonist that has been gaining popularity for sedation in pediatric intensive care unit settings . It is currently not approved by the Food and Drug Administration for use in children but is being used off‐label.…”

“…D exmedetomidine is an alpha-2 adrenergic agonist that has been gaining popularity for sedation in pediatric intensive care unit settings. [1][2][3] It is currently not approved by the Food and Drug Administration for use in children but is being used off-label. By purportedly maintaining ventilation and airway patency, it is thought to have an advantage over other types of sedatives.…”