Levels of Sedation Associated with Dexmedetomidine Versus Midazolam in Critically-Ill Mechanically-Ventilated Children

Introduction:

There is a paucity of data comparing dexmedetomidine to midazolam for sedation in mechanically-ventilated pediatric patients. While benzodiazepine-based regimens have been shown to provide a deeper level of sedation and are associated with a higher incidence of delirium in adults, the effects may be different in children. Only one prospective study has directly compared levels of sedation with two different doses of dexmedetomidine versus midazolam in thirty pediatric patients. While this study found that dexmedetomidine produced similar sedation scores as midazolam, the doses of both agents are not necessarily reflective of what is commonly used in our clinical practice. 

Objectives:

We sought to determine the levels of sedation associated with dexmedetomidine, midazolam or combination therapy for maintaining mechanical ventilation.  

Study Design:

We performed a retrospective chart review of twenty-five mechanically-ventilated patients in our pediatric intensive care unit that received a continuous infusion of dexmedetomidine, midazolam or both agents for at least twenty-four consecutive hours. 

Methods:

We assessed the depth of sedation through the State Behavioral Scale and frequency of ‘as needed’ rescue sedatives. 

Results:

Levels of sedation and frequency of rescue or intermittent sedatives were similar between all three groups. Among the twenty-five patients there were four documented cases of delirium and one unplanned extubation. 

Conclusions:

Based on these results the sedative agent should be based on patient-specific factors, provider familiarity and cost. Additional research is warranted to optimize sedation practices for mechanically-ventilated critically-ill children.