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.
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.
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.
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.
Yañez LJ, Yunge M, Emilfork M, Lapadula M, Alcántara A, Fernández C, Lozano J, Contreras M, Conto L, Arevalo C, Gayan A, Hernández F, Pedraza M, Feddersen M, Bejares M, Morales M, Mallea F, Glasinovic M, Cavada G. A prospective, randomized, controlled trial of noninvasive ventilation in pediatric acute respiratory failure. Pediatr Crit Care Med. 2008;9(5):484–9. CrossRefPubMed
Essouri S, Carroll C. and Group., Pediatric Acute Lung Injury Consensus Conference. Noninvasive support and ventilation for pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;6(5 Suppl 1):S102–10. CrossRef
Vet NJ, Ista E, de Wildt SN, et al. Optimal sedation in pediatric intensive care patients: a systematic review. Intensive Care Med. 2013;39(9):1524-34.
Chidini G, De Luca D, Conti G, Pelosi P, Nava S, Calderini E. Early Noninvasive Neurally Adjusted Ventilatory Assist Versus Noninvasive Flow-Triggered Pressure Support Ventilation in Pediatric Acute Respiratory Failure: A Physiologic Randomized Controlled Trial. Pediatr Crit Care Med. 2016:e487–95.
Ducharme-Crevier L, Beck J, Essouri S, Jouvet P, Emeriaud G. Neurally adjusted ventilatory assist (NAVA) allows patient-ventilator synchrony during pediatric noninvasive ventilation: a crossover physiological study. Crit Care. 2015;17(19):44. CrossRef
Committee. British Thoracic Society Standards of CareNon-invasive ventilation in acute respiratory failure. Thorax. 2002;57(3):192–211. CrossRef
Hilbert G, Clouzeau B, Nam Bui H, Vargas F. Sedation during non-invasive ventilation. Minerva Anestesiol. 2012;78(7):842–6. PubMed
D. De Luca, M. Piastra, G. Conti. Ventilazione non invasiva in età pediatrica e neonatale. [book auth.] G. Conti, M. Ranieri M. Antonelli. Ventilazione meccanica invasiva e non invasiva: dalla fisiologia alla clinica. Milano: Elsevier, 2012, p. Capitolo 19.
A. Concha, A. Medina, M. Pons and F. Martinón-Torres. Non-invasive ventilation interfaces. [book auth.] M Pons, F Martinon-Torres A Medina. Non-invasive ventilation in pediatrics. Barcelona: Ergon, 2009, p. Capitolo 5.
Grant MJ, Schneider JB, Asaro LA, et al. Dexmedetomidine Use in Critically Ill Children With Acute Respiratory Failure. Pediatr Crit Care Med. 2016;17(12):1131-41.
Chrysostomou C, Di Filippo S, Manrique AM, Schmitt CG, Orr RA, Casta A, Suchoza E, Janosky J, Davis PJ, Munoz R. Use of dexmedetomidine in children after cardiac and thoracic surgery. Pediatr Crit Care Med. 2006 7(2):126–131.
- Dexmedetomidine is effective and safe during NIV in infants and young children with acute respiratory failure
D. De Luca
- BioMed Central
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