title: Cardiovascular Effects of Continuous Dexmedetomidine Infusion Without a Loading Dose in the Pediatric Intensive Care Unit.
abstract: BACKGROUND
  Use of dexmedetomidine in pediatric critical care is common, despite lack of prospective studies on its hemodynamic effects.
  
  
  OBJECTIVE
  To describe cardiovascular effects in critically ill children treated with a constant continuous infusion of dexmedetomidine without a loading dose at highest Food and Drug Administration-approved adult dose.
  
  
  METHODS
  Prospective, pilot study of 17 patients with dexmedetomidine infused at a rate of 0.7 μg/kg/h for 6 to 24 hours. Heart rate (HR) and blood pressure (BP) values over time were analyzed by a random effects mixed model.
  
  
  RESULTS
  Patients with median age of 1.6 years (1 month to 17 years) and median weight of 11.8 kg (2.8-84 kg) received an infusion for a mean of 16 ± 7.2 hours. There were no cardiac conduction abnormalities. One patient required discontinuation of infusion for predetermined low HR termination criteria at hour 13 of infusion; there was no clinical compromise and it coincided with planned extubation. Decreased HR of 20% from baseline was found in 35% of patients. The mean HR reduction was largest at hour 13 of infusion with a decrease of 13 ± 17 bpm from baseline, but HR changes over time were not statistically significant. Blood pressure effects included a decrease in 12% and an increase in 29%. There was a small but statistically significant increase in systolic BP of 0.4 mm Hg/h of infusion, P < .001.
  
  
  CONCLUSIONS
  A continuous infusion of 0.7 μg/kg/h of dexmedetomidine without a loading dose for up to 24 hours in critically ill children had tolerable effects on HR and BP.
authors.affiliation: Pediatric Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA bmcummings@partners.org.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Cummings
authors.affiliation: Pediatric Critical Care, Connecticut Children's Medical Center, University of Connecticut, Hartford, CT, USA.
authors.forename: Allison S
authors.initials: AS
authors.lastname: Cowl
authors.affiliation: Pediatric Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Phoebe H
authors.initials: PH
authors.lastname: Yager
authors.affiliation: Pediatrics, Pediatric Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Chadi M
authors.initials: CM
authors.lastname: El Saleeby
authors.affiliation: Pediatric Anesthesia, Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Erik S
authors.initials: ES
authors.lastname: Shank
authors.affiliation: Pediatric Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Natan
authors.initials: N
authors.lastname: Noviski
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000493:pharmacokinetics; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine
keywords: critical care; dexmedetomidine; pediatrics; safety