WIP 24 - Determining the effect of Dexmedetomidine (Precedex) in allowing tolerance of NIV in children with Bronchiolitis admitted to the Pediatric Intensive Care Unit
Resident Physician Albany Medical Center Albany, New York, United States
Background: Non-invasive ventilation (NIV) is increasingly required for acute hypoxic respiratory failure (AHRF) in children admitted with bronchiolitis. However, patients often struggle with interface intolerance and agitation. Sedation in these children can help maintain ventilator synchrony, increasing efficiency and efficacy of NIV, but respiratory suppressive side effects raise concerns and data regarding sedation during NIV in pediatric intensive care unit (PICU) has been limited. Dexmedetomidine (DEX) has emerged as a sedative with no significant effect on respiratory depression, however, there exists a wide variability regarding its use during NIV in the PICU. To date, few studies report the use of DEX as a single pediatric sedative agent for bronchiolitis requiring NIV. Objective: In this retrospective study, we aim to describe our single center experience with the safety profile and efficacy of DEX as a single sedative agent for children with acute hypoxic respiratory failure secondary to viral bronchiolitis requiring NIV. Design/Methods: Retrospective chart review of pediatric patients between the ages of 3 months and 5 years admitted to a single-center tertiary PICU between June 2017 and June 2022 was conducted. Patients with AHRF and a discharge diagnosis of viral bronchiolitis, on NIV for a minimum of 8 hours, and on DEX were included. Demographic, clinical, laboratory, and outcome data as well as treatment information were extracted into RedCAP, an online anonymized database. Drug related adverse effect profiles, maximum dose and length of time of DEX infusion, failure of NIV resulting in invasive mechanical ventilation, length of PICU and hospital stay and duration of NIV use will be reported in the final descriptive analysis. The primary outcome is defined as the rate of NIV failure and secondary outcomes include the rate of DEX-related cardiovascular adverse effects. T-tests, Pearson’s chi squared test, Fisher’s exact test, or Wilcoxon rank sum tests will be applied as appropriate. Data analysis will be finalized by February, with manuscript writing to commence.
