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. 2018 Aug 25;18(1):282.
doi: 10.1186/s12887-018-1256-y.

Dexmedetomidine is effective and safe during NIV in infants and young children with acute respiratory failure

M Piastra  1 , A Pizza  2 , S Gaddi  1 , E Luca  1 , O Genovese  1 , E Picconi  1 , D De Luca  3 , G Conti  1
Affiliations

Dexmedetomidine is effective and safe during NIV in infants and young children with acute respiratory failure

M Piastra et al. BMC Pediatr. .

Abstract

Background: Noninvasive ventilation (NIV) is increasingly utilized in infants and young children, though associated with high failure rates due to agitation and poor compliance, mostly if patient-ventilator synchronization is required.

Methods: A retrospective cohort study was carried out in an academic pediatric intensive care unit (PICU). Dexmedetomidine (DEX) was infused as unique sedative in 40 consecutive pediatric patients (median age 16 months) previously showing intolerance and agitation during NIV application.

Results: During NIV clinical application both COMFORT-B Score and Richmond Agitation-Sedation Scale (RASS) were serially evaluated. Four patients experiencing NIV failure, all due to pulmonary condition worsening, required intubation and invasive ventilation. 36 patients were successfully weaned from NIV under DEX sedation and discharged from PICU. All patients survived until home discharge.

Conclusion: Our data suggest that DEX may represent an effective sedative agent in infants and children showing agitation during NIV. Early use of DEX in infants/children receiving NIV for acute respiratory failure (ARF) should be considered safe and capable of improving NIV, thus permitting both lung recruitment and patient-ventilator synchronization.

Keywords: Acute respiratory failure; Dexmedetomidine; Infant; Non invasive ventilation; Sedation.

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Conflict of interest statement

Ethics approval and consent to participate

The Ethical Committee “Comitato Etico dell’Università Cattolica Del Sacro Cuore” approved the study and waived the need for informed consent. Reference number 26257/14.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Arterial gas analysis and respiratory parameters during NIV in DEX. P/F: PaO2 /FiO2 ratio; B: Basal; I: after 8 h; II; after 24 h; E (End): after 48 h
Fig. 2
Fig. 2
Correlation between PICU stay (d) and NIV duration (hrs), PRISM (n) and age (in months) of infants undergoing NIV during DEX sedation
Fig. 3
Fig. 3
Trend in HR (bpm) and MAP (torr) in infants undergoing NIV
Fig. 4
Fig. 4
COMFORT B score and RASS score during NIV application
See this image and copyright information in PMC

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