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Dexmedetomidine and Iatrogenic Withdrawal Syndrome in Critically Ill Children

Barbara M Geven1, Jolanda M Maaskant2, Catherine S Ward3

  • 1Barbara M. Geven is a pediatric intensive care nurse and clinical epidemiologist, Amsterdam UMC/Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands.

Critical Care Nurse
|February 9, 2021
PubMed

Insights

Supplemental dexmedetomidine did not prevent iatrogenic withdrawal syndrome in pediatric intensive care unit patients on mechanical ventilation. Higher midazolam doses were linked to increased withdrawal symptoms.

Area of Science:

  • Pediatric Intensive Care
  • Pharmacology
  • Critical Care Medicine

Background:

  • Iatrogenic withdrawal syndrome (IWS) is a common adverse effect in pediatric patients on mechanical ventilation, with incidence up to 64.6%.
  • Standard sedatives and analgesics may be insufficient, leading to the use of supplemental dexmedetomidine.
  • The impact of dexmedetomidine on IWS in this population remains unclear.

Purpose of the Study:

  • To investigate the potential preventive effect of dexmedetomidine on IWS.
  • To assess dexmedetomidine as an adjunct to standard morphine and midazolam regimens.
  • To evaluate IWS development in mechanically ventilated pediatric intensive care unit patients.

Main Methods:

  • Retrospective observational study in a 10-bed general pediatric intensive care unit.
  • Data collected from 102 patients receiving mechanical ventilation.
  • Iatrogenic withdrawal syndrome assessed using the Sophia Observation withdrawal Symptoms-scale.

Main Results:

  • Cumulative dexmedetomidine dose showed no preventive effect on IWS (P = .19).
  • After adjusting for baseline characteristics, cumulative midazolam dose was a significant risk factor for IWS (P < .03).

Conclusions:

  • Supplemental dexmedetomidine does not appear to prevent IWS in pediatric ICU patients.
  • Midazolam cumulative dose is identified as a significant risk factor for developing IWS.
  • Further research may be needed to identify effective strategies for preventing IWS.
Abstract

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