Safety and feasibility of dexmedetomidine for sedation in pediatric patients receiving non-invasive respiratory support: a descriptive study

Background Non-Invasive Respiratory Support (NIRS) is frequently utilized in pediatric patients with moderate to severe acute respiratory failure; however, patient non-compliance can significantly reduce treatment success. Dexmedetomidine (DEX) is widely utilized in adult populations for its sedative and anxiolytic properties, but its use in pediatric populations has been limited, despite an increase in recent years. This study aimed to evaluate the clinical feasibility, physiological trends, and documented adverse events of DEX use in pediatric patients undergoing NIRS. Methods This retrospective study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Batman Training and Research Hospital between June 1, 2022, and December 30, 2022, who were administered DEX. All patients received NIRS, including continuous positive airway pressure (CPAP) or high-flow oxygen therapy. Patient data were analyzed using descriptive statistics and compared according to variables such as age, DEX dosage, side effects, gender, heart rate, and respiratory rate. Results A total of 93% of patients were treated for moderate to severe acute respiratory failure. The cohort consisted of 46% females and 54% males. Age distribution was as follows: 55.8% were aged 1–12 months, 34.5% were 13–36 months, and 9.72% were older than 36 months. A significant reduction in RR and HR was observed following the initiation of combined NIRS and dexmedetomidine therapy ( p < 0.001). Adverse effects were observed in a small number of patients: bradycardia in two, elevated liver enzyme levels in two, and hypotension in one. No adverse events were reported in the remaining 108 patients. In our cohort, high-flow oxygen therapy via High-Flow Nasal Cannula (HFNC) was administered with a nasal cannula, CPAP was delivered via nasal masks, and DEX was administered via infusion at a dose of 0.1–0.6 µg/kg/h without a loading dose. The overall descriptive rate of successful NIRS completion without escalation to invasive ventilation was 98.2% (111/113). Stratified analysis demonstrated a 98% (100/102) success rate in the primary NIRS subgroup (prevention of intubation) and a 100% (11/11) success rate in the post-extubation subgroup (prevention of re-intubation). Conclusion Dexmedetomidine monotherapy appears to be a feasible and clinically well-tolerated sedative adjunct for pediatric patients receiving non-invasive respiratory support. Prospective comparative trials are warranted to further investigate these findings.