Oluwasinmisola Opeyemi
University of Pittsburgh School of Medicine
Disclosure information not submitted.
Karryn Crisamore, PharmD
PhD Candidate
University of Pittsburgh School of Pharmacy
Pittsburgh, Pennsylvania, United States
Disclosure information not submitted.
.jpeg.jpg "Jonathan Pelletier, MD photo")
Jonathan Pelletier, MD
Clinical Instructor
Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Disclosure information not submitted.
.jpg "Jaskaran Rakkar, MD photo")
Jaskaran Rakkar, MD
UPMC Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Alicia Au, MD
Assistant Professor, Critical Care Medicine. Associate Medical Director, PICU
Children's Hospital of Pittsburgh of UPMC, United States
Disclosure information not submitted.
Philip E. Empey, BCPS, PharmD, PhD
Associate Professor, Pharmacy and Therapeutics
University of Pittsburgh, United States
Disclosure information not submitted.
Robert Clark, MD, FCCM
Professor of Critical Care Medicine and Pediatrics
Childrens Hospital of Pittsburgh of UPMC, United States
Disclosure information not submitted.
Christopher Horvat, MD, MHA
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
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Title: Is Dexmedetomidine Associated with Decreased Opioid Requirement Among Critically Ill Children?
Introduction/Hypothesis: Children admitted to the pediatric intensive care unit (PICU) often require potent sedative and analgesic medications to treat pain associated with their illness. Dexmedetomidine (DEX) is a commonly used sedative that may also reduce the requirement for other sedative-analgesic medications, including opioids. We hypothesized that the use of DEX among children with respiratory failure receiving a concomitant opioid infusion would be associated with reduced total opioid dose.
Methods: This is a retrospective cohort of children admitted to the PICU between 2010 and 2019 at a quaternary children’s hospital. Inclusion criteria were non-surgical admissions receiving mechanical ventilation with a concomitant opioid infusion for the first 72 hours of PICU admission. Multivariable linear regression was used to identify factors associated with mean opioid exposure between hours 24 and 72. A propensity matched analysis examined opioid exposure after adjusting for factors associated with DEX delivery in the first 24 hours of PICU admission. Rosenbaum sensitivity analysis assessed the vulnerability of the model to lurking confounders.
Results: 671 encounters met inclusion criteria, with 142 (21%) receiving a DEX infusion in the first 24 hours. There were no significant differences in age, sex, and race between the early and no DEX groups. The regression model explained 43.8% of the variance in mean opioid exposure. In the propensity matched analysis, initiation of an early DEX infusion within the 1st 24 hours of PICU admission was significantly associated with an estimated greater mean 48-hr opioid exposure compared to patients who did not receive DEX (estimated increase of 0.50 mili-morphine-equivalent per kilogram, P=0.007). Sensitivity analysis indicated a gamma of 1.4 as the threshold for non-significance.
Conclusions: Early DEX was significantly associated with greater mean 48-hr opioid exposure among children admitted to the PICU with respiratory failure, though the model accounted for less than half of the variance in opioid dose requirements and the findings appear sensitive to unmeasured confounding. Additional, prospective work is required to identify individual traits, including pharmacogenomic factors, associated with response to sedative analgesic medications.