PMID- 30394067
OWN - NLM
STAT- MEDLINE
DCOM- 20200311
LR  - 20200311
IS  - 1827-1596 (Electronic)
IS  - 0375-9393 (Linking)
VI  - 85
IP  - 2
DP  - 2019 Feb
TI  - Prolonged sedation in critically ill children: is dexmedetomidine a safe option 
      for younger age? An off-label experience.
PG  - 164-172
LID - 10.23736/S0375-9393.18.13062-8 [doi]
AB  - BACKGROUND: 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). METHODS: 
      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. RESULTS: 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). CONCLUSIONS: 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.
FAU - Sperotto, Francesca
AU  - Sperotto F
AD  - Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, 
      University Hospital of Padua, Padua, Italy - francesca.sperotto@gmail.com.
FAU - Mondardini, Maria C
AU  - Mondardini MC
AD  - Unit of Pediatric Intensive Care, S. Orsola Malpighi Hospital, University of 
      Bologna, Bologna, Italy.
FAU - Vitale, Francesca
AU  - Vitale F
AD  - Unit of Pediatric Intensive Care, A. Gemelli Hospital, Sacred Heart Catholic 
      University, Rome, Italy.
FAU - Daverio, Marco
AU  - Daverio M
AD  - Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, 
      University Hospital of Padua, Padua, Italy.
FAU - Campagnano, Emiliana
AU  - Campagnano E
AD  - Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, 
      University Hospital of Padua, Padua, Italy.
FAU - Ferrero, Federica
AU  - Ferrero F
AD  - Unit of Pediatric and Neonatal Intensive Care, Maggiore della Carita Hospital, 
      Novara, Italy.
FAU - Rossetti, Emanuele
AU  - Rossetti E
AD  - Unit of Pediatric Intensive Care, Bambino Gesu Children's Hospital, Rome, Italy.
FAU - Vasile, Beatrice
AU  - Vasile B
AD  - Department of Pediatric Anesthesia and Intensive Care, Spedali Civili Hospital, 
      University of Brescia, Brescia, Italy.
FAU - Dusio, Maria P
AU  - Dusio MP
AD  - Unit of Pediatric Intensive Care, C. Arrigo Children's Hospital, Alessandria, 
      Italy.
FAU - Ferrario, Stefania
AU  - Ferrario S
AD  - Unit of Pediatric Intensive Care, V. Buzzi Children's Hospital, Milan, Italy.
FAU - Savron, Fabio
AU  - Savron F
AD  - Unit of Pediatric Intensive Care, Burlo Garofalo Hospital, University of Trieste, 
      Trieste, Italy.
FAU - Brugnaro, Luca
AU  - Brugnaro L
AD  - Department Education and Training, University Hospital of Padua, Padua, Italy.
FAU - Amigoni, Angela
AU  - Amigoni A
AD  - Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, 
      University Hospital of Padua, Padua, Italy.
CN  - Pediatric Neurological Protection and Drugs (PeNPAD) Study Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20181030
PL  - Italy
TA  - Minerva Anestesiol
JT  - Minerva anestesiologica
JID - 0375272
RN  - 0 (Hypnotics and Sedatives)
RN  - 67VB76HONO (Dexmedetomidine)
SB  - IM
MH  - Child, Preschool
MH  - *Critical Illness
MH  - Deep Sedation/*adverse effects
MH  - Delirium/chemically induced/epidemiology
MH  - Dexmedetomidine/administration & dosage/*adverse effects
MH  - Drug Interactions
MH  - Female
MH  - Hemodynamics/drug effects
MH  - Humans
MH  - Hypnotics and Sedatives/administration & dosage/*adverse effects
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Off-Label Use
MH  - Retrospective Studies
MH  - Substance Withdrawal Syndrome/epidemiology
FIR - Caramelli, Fabio
IR  - Caramelli F
FIR - Conti, Giorgio
IR  - Conti G
FIR - Furlan, Stefano
IR  - Furlan S
FIR - Molinaro, Silvana
IR  - Molinaro S
FIR - Pettenazzo, Andrea
IR  - Pettenazzo A
FIR - Picardo, Sergio
IR  - Picardo S
FIR - Racca, Fabrizio
IR  - Racca F
FIR - Salvo, Ida
IR  - Salvo I
EDAT- 2018/11/06 06:00
MHDA- 2020/03/12 06:00
CRDT- 2018/11/06 06:00
PHST- 2018/11/06 06:00 [pubmed]
PHST- 2020/03/12 06:00 [medline]
PHST- 2018/11/06 06:00 [entrez]
AID - S0375-9393.18.13062-8 [pii]
AID - 10.23736/S0375-9393.18.13062-8 [doi]
PST - ppublish
SO  - Minerva Anestesiol. 2019 Feb;85(2):164-172. doi: 10.23736/S0375-9393.18.13062-8. 
      Epub 2018 Oct 30.