J Pediatr Intensive Care
DOI: 10.1055/s-0042-1753537
Original Article

Patient-Specific Factors Associated with Dexmedetomidine Dose Requirements in Critically Ill Children

Karryn R. Crisamore 
1   Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, United States
,
Philip E. Empey 
3   Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA
,
Jonathan H. Pelletier
2   Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, United States
,
Robert S. B. Clark
2   Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, United States
,
Christopher M. Horvat 
2   Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, United States
› Author Affiliations
Funding This work was supported by the American Foundation for Pharmaceutical Education [to K.R.C.], The National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) under Award Number TL1TR001858 [to K.R.C.], and the National Institute of Child Health and Human Development (NICHD) of the NIH under Award Numbers 5T32HD040686-20 [to J.H.P.], and 1K23HD099331-01A1 [to C.M.H.]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
› Further Information
Also available ateRef
  Permissions and Reprints
Preview

Abstract

The objective of this study was to evaluate patient-specific factors associated with dexmedetomidine dose requirements during continuous infusion. A retrospective cross-sectional analysis of electronic health record-derived data spanning 10 years for patients admitted with a primary respiratory diagnosis at a quaternary children's hospital and who received a dexmedetomidine continuous infusion (n = 346 patients) was conducted. Penalized regression was used to select demographic, clinical, and medication characteristics associated with a median daily dexmedetomidine dose. Identified characteristics were included in multivariable linear regression models and sensitivity analyses. Critically ill children had a median hourly dexmedetomidine dose of 0.5 mcg/kg/h (range: 0.1–1.8), median daily dose of 6.7 mcg/kg/d (range: 0.9–38.4), and median infusion duration of 1.6 days (range: 0.25–5.0). Of 26 variables tested, 15 were selected in the final model with days of dexmedetomidine infusion (β: 1.9; 95% confidence interval [CI]: 1.6, 2.3), median daily morphine milligram equivalents dosing (mg/kg/d) (β: 0.3; 95% CI: 0.1, 0.5), median daily ketamine dosing (mg/kg/d) (β: 0.2; 95% CI: 0.1, 0.3), male sex (β: −1.1; 95% CI: −2.0, −0.2), and non-Black reported race (β: −1.2; 95% CI: −2.3, −0.08) significantly associated with median daily dexmedetomidine dose. Approximately 56% of dose variability was explained by the model. Readily obtainable information such as demographics, concomitant medications, and duration of infusion accounts for over half the variability in dexmedetomidine dosing. Identified factors, as well as additional environmental and genetic factors, warrant investigation in future studies to inform precision dosing strategies.

Keywords

sedation - precision medicine - dexmedetomidine

Supplementary Material



Publication History

Received: 08 February 2022

Accepted: 07 June 2022

Article published online:
02 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany