Dexmedetomidine as Single Continuous Sedative During Noninvasive Ventilation: Typical Usage, Hemodynamic Effects, and Withdrawal

Objectives: Dexmedetomidine use in pediatric critical care is increasing. Its prolonged effects as a single continuous agent for sedation are not well described. The aim of the current study was to describe prolonged dexmedetomidine therapy without other continuous sedation, specifically the hemodynamic effects, discontinuation strategies, and risk factors for withdrawal. Design: Retrospective chart review. Setting: Large, single-center, quaternary care pediatric academic institution. Patients: Data from 382 children, less than 18 years old admitted to the PICU who received dexmedetomidine for more than 24 hours without other infusions for sedation during noninvasive positive pressure ventilation. Interventions: Usual care practices for dexmedetomidine use were described. Discontinuation strategies were categorized as abrupt discontinuation, wean from dexmedetomidine infusion, and transition to enteral clonidine. Measurements and Main Results: Median peak and cumulative doses with interquartile range were 1 µg/kg/hr (0.6–1.2 µg/kg/hr) and 30 µg/kg (20–50 µg/kg), respectively, and median duration was 45 hours (34–66 hr). Four hours after reaching peak dose, we observed a decrease in heart rate (p

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