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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.
- dexmedetomidine
- noninvasive ventilation
- moderate sedation
- hypnotics and sedatives
- pediatrics
- pediatric ICUs
Footnotes
- Correspondence: Dr. Daniel B. Eidman MD, Department of Pediatrics, Division of Pediatric Critical Care, NYU Langone Health, New York, New York. E-mail: daniel.eidman{at}nyulangone.org
See the Related Editorial on Page 377
There was no external funding for this study.
The authors have disclosed no conflicts of interest.
The study was performed at Yale-New Haven Children’s Hospital, New Haven, Connecticut.
Dr Couloures previously presented the research data at the Society of Critical Care Medicine 46th Critical Care Congress held January 21–25, 2017, in Honolulu, Hawaii.
Dr Eidman previously presented a version of this paper at the Society of Critical Care Medicine 49th Critical Care Congress held February 16–19, 2020, in Orlando, Florida
- Copyright © 2022 by Daedalus Enterprises
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