Use of dexmedetomidine for sedation in critically ill mechanically ventilated pediatric burn patients

Dexmedetomidine has previously been used only for short-term, procedural sedation in children. The purpose of this review was to describe the dosing, safety, and efficacy of dexmedetomidine for sustained sedation in intubated pediatric burn patients. The authors reviewed acutely burned children treated between 2005 and 2008 who were intubated during their course of care and who received dexmedetomidine for sedation. Patients served as their own controls using the time periods when they received sedatives other than dexmedetomidine. Eleven patients with 17 dexmedetomidine treatment courses were identified. The median patient age was 7 years (range 1.6-17 years), and median burn size was 30.5% TBSA (range 6-59%). Patients were ventilated for a median of 9 days (range 4-46 days). The median initial dose of dexmedetomidine was 0.39 μg/kg/hr (range 0.10-1.16 μg/kg/hr), with a median infusion dose of 0.57 μg/kg/hr (range 0.11-1.17 μg/kg/hr) and median treatment duration of 40 hours (range 1-356 hours). None of the patients received dexmedetomidine loading dose. Patients achieved more appropriate Riker scores while treated with dexmedetomidine than while being treated with other sedatives (3.8 vs 3.3, P = .003). The incidence of hypotension and/or bradycardia while on dexmedetomidine was not greater than when it was not being used. Clinically significant rebound hypertension and tachycardia were absent on discontinuation of dexmedetomidine. No unplanned extubations were observed. Median length of hospital stay was 49 days (range 7-118 days). Dexmedetomidine seems to be safe and effective for sedation of pediatric burn patients on mechanical ventilation with close cardiovascular monitoring.