Venkatraman Rasika, Hungerford James L, Hall Mark W, Moore-Clingenpeel Melissa, Tobias Joseph D
1Division of Critical Care, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH. 2Emory Sleep Center, Emory University, Atlanta, GA. 3Critical Care Medicine, Children's Healthcare of Atlanta, Children's at Egleston, Atlanta, GA. 4Biostatistics Core, The Research Institute at Nationwide Children's Hospital, Columbus, OH. 5Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH. 6Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH.
Pediatr Crit Care Med. 2017 Sep;18(9):831-837. doi: 10.1097/PCC.0000000000001226.
To describe the use of dexmedetomidine for sedation in a large cohort of nonintubated children with acute respiratory insufficiency receiving noninvasive ventilatory support.
Single-center, retrospective, observational cohort study.
A large quaternary-care PICU.
The study cohort included 202 children receiving noninvasive ventilatory and a dexmedetomidine infusion within 48 hours of PICU admission over a 6-month period.
None.
The primary respiratory diagnoses in the cohort (median age, 2 yr) included status asthmaticus (60%) and bronchiolitis (29%). Dexmedetomidine was infused for a median of 35 hours with a median hourly dose across the patient cohort of 0.61 μg/kg/hr (range, 0.4-0.8 μg/kg/hr). The target sedation level was achieved in 168 patients (83%) in the cohort for greater than or equal to 80% of the recorded values over the entire noninvasive ventilatory course, with dexmedetomidine as the only continuously administered sedative agent. While vital signs were frequently abnormal relative to age-based norms, clinical interventions were needed rarely to treat bradycardia (13%), hypotension (20%), and hypopnea (5%). The most frequently used of these interventions was a dexmedetomidine dose reduction, fluid bolus, and titration of noninvasive ventilatory support. Five patients (2.5%) required endotracheal intubation: three due to progression of their respiratory illness, one with septic shock, and one with apnea requiring resuscitation. In 194 of 202 patients (96%), the outcome of the noninvasive ventilatory course was successful with the patient being weaned from noninvasive respiratory support to nasal cannula or room air.
Dexmedetomidine was often effective as a single continuous sedative infusion during pediatric noninvasive ventilatory. Cardiorespiratory events associated with its use were typically mild and/or reversible with dose reduction, fluid administration, and/or noninvasive ventilatory titration. Prospective studies comparing dexmedetomidine with other agents in this setting are warranted.
描述右美托咪定在一大群接受无创通气支持的急性呼吸功能不全的非插管儿童中用于镇静的情况。
单中心、回顾性、观察性队列研究。
一家大型四级医疗儿科重症监护病房。
研究队列包括在6个月期间入住儿科重症监护病房48小时内接受无创通气并输注右美托咪定的202名儿童。
无。
队列中的主要呼吸道诊断（中位年龄2岁）包括哮喘持续状态（60%）和细支气管炎（29%）。右美托咪定输注的中位时间为35小时，整个患者队列的中位每小时剂量为0.61μg/kg/小时（范围0.4 - 0.8μg/kg/小时）。在整个无创通气过程中，队列中的168名患者（83%）达到目标镇静水平的时间超过记录值的80%，右美托咪定是唯一持续使用的镇静剂。虽然相对于基于年龄的标准，生命体征经常异常，但很少需要临床干预来治疗心动过缓（13%）、低血压（20%）和呼吸浅慢（5%）。这些干预措施中最常用的是减少右美托咪定剂量、静脉推注液体和调整无创通气支持。5名患者（2.5%）需要气管插管：3名是由于呼吸系统疾病进展，1名患有感染性休克，1名因呼吸暂停需要复苏。在202名患者中的194名（96%）中，无创通气过程成功，患者从无创呼吸支持撤机至鼻导管吸氧或室内空气。
右美托咪定在儿科无创通气期间作为单一持续镇静输注通常有效。与其使用相关的心肺事件通常较轻和/或通过减少剂量、补液和/或调整无创通气可逆转。有必要进行前瞻性研究比较右美托咪定与其他药物在这种情况下的效果。
