Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy -
Unit of Pediatric Intensive Care, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
Minerva Anestesiol. 2019 Feb;85(2):164-172. doi: 10.23736/S0375-9393.18.13062-8. Epub 2018 Oct 30.
Dexmedetomidine (DEX) is an alpha-2-adrenergic agonist, recently approved by Italian-Medicines-Agency for difficult sedation in pediatrics, but few data exist regarding prolonged infusions in critically-ill children, especially in younger ages. Aim of our study was to evaluate DEX use and safety for prolonged sedation in Pediatric Intensive Care Units (PICUs).
Patients receiving DEX for ≥24 hours were retrospectively evaluated to analyze DEX indications, dosages, use of analgesics or sedatives, adverse events (AEs), withdrawal syndrome or delirium.
Forty-seven patients (median 0.7years) from nine PICUs were enrolled. Main indications were adjuvant for drugs sparing (59.6%) and for analgosedation weaning (36.2%). Median infusion duration was 82.0 hours (IQR 62.2-126.0), with dosages between 0.4 (IQR 0.2-0.5) and 0.8 mcg/kg/h (IQR 0.6-1.2). Fifty-nine-percent of patients received other sedatives, 83% other analgesics. Twenty-one-percent presented withdrawal syndrome, 4.2% delirium, none of them DEX-related. Forty-six-percent experienced a potentially-DEX-related AE. AEs were all hemodynamic, 14.9% requiring intervention but none DEX interruption. The median minimum and maximum dosages were significantly higher in patients with AEs (0.5 vs. 0.3,P=0.001; 1.0 vs. 0.7,P<0.001), without correlations with the infusion duration. AEs rate was higher in patients receiving benzodiazepines (P=0.020) or more than one analgesic (P=0.003) and in those presenting withdrawal syndrome (P<0.001).
DEX was confirmed as useful and relatively safe drug for prolonged sedation in critically-ill children, particularly in younger ages. Main AEs were cardiovascular, reversible, related with higher doses, with the concomitant use of benzodiazepines or multiple sedation drugs and with the presence of withdrawal syndrome.
右美托咪定（DEX）是一种 α-2-肾上腺素能激动剂，最近被意大利药品管理局批准用于儿科困难镇静，但关于危重病儿童长时间输注的资料很少，特别是在较小年龄的儿童。我们研究的目的是评估 DEX 在儿科重症监护病房（PICU）中用于长时间镇静的使用情况和安全性。
回顾性评估接受 DEX 治疗≥24 小时的患者，以分析 DEX 的适应证、剂量、镇痛药或镇静剂的使用、不良事件（AE）、撤药综合征或谵妄。
共纳入 9 个 PICU 的 47 名患者（中位数 0.7 岁）。主要适应证为辅助药物节约（59.6%）和为镇痛镇静停药（36.2%）。中位输注时间为 82.0 小时（IQR 62.2-126.0），剂量为 0.4（IQR 0.2-0.5）至 0.8 mcg/kg/h（IQR 0.6-1.2）。59%的患者接受了其他镇静剂，83%的患者接受了其他镇痛药。21%的患者出现撤药综合征，4.2%的患者出现谵妄，均与 DEX 无关。46%的患者发生了潜在的 DEX 相关 AE。AE 均为血流动力学相关，14.9%需要干预，但均无需中断 DEX。有 AE 的患者的最低和最高剂量中位数明显更高（0.5 比 0.3，P=0.001；1.0 比 0.7，P<0.001），但与输注时间无关。同时使用苯二氮䓬类药物（P=0.020）或使用超过一种镇痛药（P=0.003）以及出现撤药综合征的患者（P<0.001）AE 发生率更高。
DEX 被证实是一种有用且相对安全的药物，可用于危重病儿童长时间镇静，特别是在较小年龄的儿童。主要 AE 为心血管相关的、可逆转的，与更高剂量相关，与同时使用苯二氮䓬类药物或多种镇静药物以及撤药综合征有关。
