• Brian M Cummings, Allison S Cowl, Phoebe H Yager, Chadi M El Saleeby, Erik S Shank, and Natan Noviski.
• Pediatric Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA bmcummings@partners.org.
• J Intensive Care Med. 2015 Dec 1; 30 (8): 512-7.

BackgroundUse of dexmedetomidine in pediatric critical care is common, despite lack of prospective studies on its hemodynamic effects.ObjectiveTo 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.MethodsProspective, 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.ResultsPatients 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.ConclusionA 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.© The Author(s) 2014.

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