Adjunct Low-Dose Dexmedetomidine for Sedation in Mechanically Ventilated Children: An Exploratory Randomized Trial
| Author | Amir Farrokhian | en |
| Author | Najmeh Forouzan | en |
| Author | Bahador Mirrahimi | en |
| Author | Seyyedeh Masumeh Hashemi | en |
| Author | Alireza Kargar | en |
| Author | Maryam Alemzadeh | en |
| Author | Seyyedeh Narjes Ahmadizadeh | en |
| Author | Azita Behzad | en |
| Author | Mohammad Abbasinazari | en |
| Orcid | Bahador Mirrahimi [0000-0001-7276-8770] | en |
| Orcid | Seyyedeh Masumeh Hashemi [0000-0003-4253-5188] | en |
| Orcid | Seyyedeh Narjes Ahmadizadeh [0000-0003-2690-6487] | en |
| Orcid | Azita Behzad [0000-0001-5399-6735] | en |
| Issued Date | 2026-12-31 | en |
| Abstract | Background: Effective sedation in the pediatric intensive care unit (PICU) is complicated by the adverse effects of benzodiazepines and opioids. Dexmedetomidine may provide a benzodiazepine-sparing alternative with distinct pharmacologic properties. Objectives: We hypothesized that adjunct, fixed low-dose, no-bolus dexmedetomidine would reduce midazolam and fentanyl exposure per ventilator-day in mechanically ventilated children. Methods: In a triple-blind randomized controlled trial, 60 mechanically ventilated patients aged 1 month to 12 years were randomized to standard sedation (continuous midazolam and fentanyl) plus low-dose dexmedetomidine (a fixed-rate continuous infusion at 0.2 µg/kg/h without a loading bolus) or matched placebo (0.9% normal saline). In both groups, midazolam and fentanyl were titrated per protocol to achieve the target Richmond Agitation-Sedation Scale (RASS) level. Results: Among 60 randomized children, adjunct fixed low-dose dexmedetomidine did not reduce the prespecified primary outcome of fentanyl or midazolam exposure per ventilator-day. Median fentanyl exposure per ventilator-day was 70.0 µg·kg-1·day-1 in the control group and 90.6 µg·kg-1·day-1 in the dexmedetomidine group; median midazolam exposure per ventilator-day was 7.0 mg·kg-1·day-1 and 9.1 mg·kg-1·day-1, respectively. Neither primary comparison remained statistically significant after Holm correction. In an unadjusted secondary analysis, the median time to first successful extubation was 6 days in the dexmedetomidine group and 15 days in the control group. This finding was exploratory and was not confirmed by the prespecified competing-risk or longitudinal ventilation analyses. Conclusions: Adjunct fixed low-dose dexmedetomidine without a loading bolus did not reduce fentanyl or midazolam exposure per ventilator-day. Early sedative-analgesic exposure was higher with dexmedetomidine, and the apparent early-extubation signal was exploratory and was not confirmed by competing-risk or longitudinal analyses of ventilation. | en |
| DOI | https://doi.org/10.5812/ijpr-170096 | en |
| URI | https://brieflands.com/journals/ijpr/articles/170096 | en |
| Keyword | Dexmedetomidine | en |
| Keyword | Midazolam | en |
| Keyword | Fentanyl | en |
| Keyword | Pediatric Intensive Care Unit | en |
| Keyword | Airway Extubation | en |
| Keyword | Ventilation | en |
| Publisher | Brieflands | en |
| Title | Adjunct Low-Dose Dexmedetomidine for Sedation in Mechanically Ventilated Children: An Exploratory Randomized Trial | en |
| Type | Research Article | en |
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