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Abstract O-23: SEDATION PRACTICE IN PAEDIATRIC INTENSIVE CARE EVALUATION (BABY SPICE) A PILOT STUDY COMPARING DEXMEDETOMIDINE TO STANDARD CARE

Long, D.1,2; Erickson, S.3F. ANZICS Paediatric Study Group

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 11
doi: 10.1097/01.pcc.0000537365.26399.6b
Oral Abstracts
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1Lady Cilento Children’s Hospital, Paediatric Critical Care Research Group, Brisbane, Australia

2Griffith University, School of Nursing and Midwifery, Brisbane, Australia

3Princess Margaret Hospital, Paediatric Intensive Care Unit, Perth, Australia

4Australian and New Zealand Intensive Care Society, Paediatric Study Group, Melbourne, Australia

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Aims & Objectives:

The use of sedatives in mechanically ventilated children is common. Adult studies have demonstrated that early deep sedation significantly predicts mortality and other studies suggest detrimental effects of benzodiazepines on developing brains. Dexmedetomidine has reported neuroprotection and arousable sedation, however there is little evidence for its use in PICU. We aimed to assess the feasibility and safety of administering dexmedetomidine compared to standard sedation.

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Methods

Pilot prospective, multicentre, randomised, controlled trial on mechanically ventilated children for greater than 24 hours. 57 patients were randomised to dexmedetomidine targeted to light sedation (SBS -1 to +1) or standard sedation based on local practice across five sites. Main feasibility outcomes were time to randomisation and proportion of SBS assessments (first 48 hours) in the light/deep sedation range. Safety outcomes were incidence of adverse events, vasopressor and device removal.

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Results

Randomisation occurred within a median (IQR) of 6.25 hrs (2.35,9) after intubation. Patients in the dexmedetomidine sedation (n=29) mean (SD) PIM3 score was 0.032 (0.034) versus 0.035 (0.066; p=0.83) in the standard sedation (n=28). A significantly higher proportion of SBS assessments were in the light sedation range (-1 to +1) in the first 48 hours (289/385 [75.06%] vs 228/361 [63.16%]; p=0.001) with dexmedetomidine. There was no difference in vasopressor use or accidental device removal. One SAE was reported in the dexmedetomidine group.

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Conclusions

Dexmedetomidine for sedation was feasible, appeared safe, and achieved early light sedation whilst minimising benzodiazepine exposure. The findings of this study justify further investigation of the use of dexmedetomidine for early goal directed sedation.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies