Dexmedetomidine Withdrawal Syndrome in Children in the PICU: Systematic Review and Meta-Analysis.
Journal
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
ISSN: 1529-7535
Titre abrégé: Pediatr Crit Care Med
Pays: United States
ID NLM: 100954653
Informations de publication
Date de publication:
01 Jan 2024
01 Jan 2024
Historique:
medline:
4
1
2024
pubmed:
19
10
2023
entrez:
19
10
2023
Statut:
ppublish
Résumé
To systematically review literature describing the clinical presentation, risk factors, and treatment for dexmedetomidine withdrawal in the PICU (PROSPERO: CRD42022307178). MEDLINE/PubMed, Cochrane, Web of Science, and Scopus databases were searched. Eligible studies were published from January 2000 to January 2022 and reported clinical data for patients younger than 21 years old following discontinuation of dexmedetomidine after greater than or equal to 24 hours of infusion. Abstracts identified during an initial search were screened and data were manually abstracted after full-text review of eligible articles. The Newcastle-Ottawa Scale was used to assess study quality. Summary statistics were provided and Spearman rank correlation coefficient was used to identify relationships between covariates and withdrawal signs. A weighted prevalence for each withdrawal sign was generated using a random-effects model. Twenty-three studies (22 of which were retrospective cohort studies) containing 28 distinct cohorts were included. Median cumulative dexmedetomidine exposure by dose was 105.95 μg/kg (range, 30-232.7 μg/kg), median dexmedetomidine infusion duration was 131.75 hours (range, 20.5-525.6 hr). Weighted estimates for proportion (95% CI) of subjects experiencing withdrawal signs across all cohorts were: hypertension 0.34 (range, 0.0-0.92), tachycardia 0.26 (range, 0.0-0.87), and agitation 0.26 (range, 0.09-0.77). Meta-analysis revealed no correlation between dexmedetomidine exposure variables and withdrawal signs. A moderate negative monotonic relationship existed between the proportion of patients who had undergone cardiac surgery and the proportion experiencing hypertension (correlation coefficient, -0.47; p = 0.048) and tachycardia (correlation coefficient, -0.57; p = 0.008), indicating that in cohorts with a higher proportion of patients who were postcardiac surgery, there were fewer occurrences of hypertension and or tachycardia. On review of the 2000-2022 literature, dexmedetomidine withdrawal may be characterized by tachycardia, hypertension, or agitation, particularly with higher cumulative doses or prolonged durations. Since most studies included in the review were retrospective, prospective studies are needed to further clarify risk factors, establish diagnostic criteria, and identify optimal management strategies.
Identifiants
pubmed: 37855676
doi: 10.1097/PCC.0000000000003376
pii: 00130478-202401000-00008
doi:
Substances chimiques
Dexmedetomidine
67VB76HONO
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
62-71Informations de copyright
Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
Déclaration de conflit d'intérêts
Dr. Hochwald disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Smith HAB, Besunder JB, Betters KA, et al.: 2022 Society of Critical Care Medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility. Pediatr Crit Care Med. 2022; 23:e74–e110
Thompson RZ, Gardner BM, Autry EB, et al.: Survey of the current use of dexmedetomidine and management of withdrawal symptoms in critically ill children. J Pediatr Pharmacol Ther. 2019; 24:16–21
Page MJ, McKenzie JE, Bossuyt PM, et al.: The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ (Clin Res Ed). 2021; 372:n71
Ma LL, Wang YY, Yang ZH, et al.: Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: What are they and which is better? Mil Med Res. 2020; 7:7
Farrah K, Young K, Tunis MC, et al.: Risk of bias tools in systematic reviews of health interventions: An analysis of PROSPERO-registered protocols. Syst Rev. 2019; 8:280
Burbano NH, Otero AV, Berry DE, et al.: Discontinuation of prolonged infusions of dexmedetomidine in critically ill children with heart disease. Intensive Care Med. 2012; 38:300–307
Gupta P, Whiteside W, Sabati A, et al.: Safety and efficacy of prolonged dexmedetomidine use in critically ill children with heart disease*. Pediatr Crit Care Med. 2012; 13:660–666
Whalen LD, Di Gennaro JL, Irby GA, et al.: Long-term dexmedetomidine use and safety profile among critically ill children and neonates. Pediatr Crit Care Med. 2014; 15:706–714
Horvath R, Halbrooks EF, Overman DM, et al.: Efficacy and safety of postoperative dexmedetomidine administration in infants and children undergoing cardiac surgery: A retrospective cohort study. J Pediatr Intensive Care. 2015; 4:138–145
Banasch HL, Dersch-Mills DA, Boulter LL, et al.: Dexmedetomidine use in a pediatric intensive care unit: A retrospective cohort study. Ann Pharmacother. 2018; 52:133–139
Beitz ER, Seabury R, Miller CD, et al.: Clonidine for dexmedetomidine withdrawal in pediatric patients: A single center’s experience. J Pediatr Pharmacol Ther. 2019; 24:542–543
Berrens ZJ, Sauro AL, Tillman EM: Prevention of withdrawal in pediatric patients receiving long-term dexmedetomidine infusions. J Pediatr Pharmacol Ther. 2021; 26:81–86
Buck ML, Willson DF: Use of dexmedetomidine in the pediatric intensive care unit. Pharmacotherapy. 2008; 28:51–57
Carney L, Kendrick J, Carr R: Safety and effectiveness of dexmedetomidine in the pediatric intensive care unit (SAD-PICU). Can J Hosp Pharm. 2013; 66:21–27
Crabtree MF, Sargel CL, Cloyd CP, et al.: Evaluation of an enteral clonidine taper following prolonged dexmedetomidine exposure in critically ill children. J Pediatr Intensive Care. 2021; 11:327–334
Dersch-Mills DA, Banasch HL, Yusuf K, et al.: Dexmedetomidine use in a tertiary care NICU: A descriptive study. Ann Pharmacother. 2019; 53:464–470
Erickson SJ, Millar J, Anderson BJ, et al.; Baby SPICE Investigators and the Australian and New Zealand Intensive Care Society Paediatric Study Group (ANZICS-PSG): Dexmedetomidine sedation in mechanically ventilated critically ill children: A pilot randomized controlled trial. Pediatr Crit Care Med. 2020; 21:e731–e739
Haenecour AS, Seto W, Urbain CM, et al.: Prolonged dexmedetomidine infusion and drug withdrawal in critically ill children. J Pediatr Pharmacol Ther. 2017; 22:453–460
Lam F, Bhutta AT, Tobias JD, et al.: Hemodynamic effects of dexmedetomidine in critically ill neonates and infants with heart disease. Pediatr Cardiol. 2012; 33:1069–1077
Lardieri AB, Fusco NM, Simone S, et al.: Effects of clonidine on withdrawal from long-term dexmedetomidine in the pediatric patient. J Pediatr Pharmacol Ther. 2015; 20:45–53
Lee MM, Caylor K, Gockenbach N: Evaluating the transition from dexmedetomidine to clonidine for the prevention of withdrawal in critically ill pediatric patients. J Pediatr Pharmacol Ther. 2020; 25:104–110
Liu J, Miller J, Ferguson M, et al.: The impact of a clonidine transition protocol on dexmedetomidine withdrawal in critically ill pediatric patients. J Pediatr Pharmacol Ther. 2020; 25:278–287
Nguyen TL, Lam WM, Orr H, et al.: Clonidine for the treatment of agitation after dexmedetomidine discontinuation in pediatric patients: A retrospective cohort study. J Pediatr Pharmacol Ther. 2021; 26:821–827
Shutes BL, Gee SW, Sargel CL, et al.: Dexmedetomidine as single continuous sedative during noninvasive ventilation: Typical usage, hemodynamic effects, and withdrawal. Pediatr Crit Care Med. 2018; 19:287–297
Solodiuk JC, Sweet E, Greco C, et al.: Weaning dexmedetomidine in non-ICU areas: An implementation effort. Pediatr Crit Care Med. 2022; 23:353–360
Sperotto F, Mondardini MC, Dell’Oste C, et al.; Pediatric Neurological Protection and Drugs (PeNPAD) Study Group of the Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI): Efficacy and safety of dexmedetomidine for prolonged sedation in the PICU: A prospective multicenter study (PROSDEX). Pediatr Crit Care Med. 2020; 21:625–636
Sperotto F, Mondardini MC, Vitale F, et al.; Pediatric Neurological Protection and Drugs (PeNPAD) Study Group: Prolonged sedation in critically ill children: Is dexmedetomidine a safe option for younger age? An off-label experience. Minerva Anestesiol. 2019; 85:164–172
Takahashi Y, Ueno K, Ninomiya Y, et al.: Potential risk factors for dexmedetomidine withdrawal seizures in infants after surgery for congenital heart disease. Brain Dev. 2016; 38:648–653
Fenn NE 3rd, Plake KS: Opioid and benzodiazepine weaning in pediatric patients: Review of current literature. Pharmacotherapy. 2017; 37:1458–1468