Intraoperative dexmedetomidine reduces postoperative mechanical ventilation in infants after open heart surgery. (Emrath)

Achuff BJ, Nicolson SC, Elci OU, Zuppa AF. Intraoperative dexmedetomidine
reduces postoperative mechanical ventilation in infants after open heart surgery.
Pediatr Crit Care Med. 2015 Feb 21. [Epub ahead of print]

Full-text for Children’s and Emory users.

OBJECTIVE: The inclusion of dexmedetomidine in the operative and postoperative management of infants with congenital heart defects has lessened the need for opioids that may cause respiratory depression. Our objective was to show that a dexmedetomidine bolus at or about the time of sternal closure is associated with a decrease in the use of mechanical ventilation in the immediate postoperative period.

DESIGN: Retrospective cohort study.

SETTING: Single pediatric tertiary cardiac center.

PATIENTS: Infants undergoing surgical intervention for congenital heart defects requiring cardiopulmonary bypass, age 30-365 days in a 5-year time period from June 1, 2008, to December 31, 2012.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Of 1,057 total encounters, 441 met inclusion criteria and were evenly distributed over the 5-year time period. Dexmedetomidine had been given at or about the time of sternal closure in 57% of patients. When the exposed and unexposed groups were compared in terms of mechanical ventilation immediately postoperative, there was a statistically significant effect of using dexmedetomidine on the odds of receiving mechanical ventilation (p = 0.0019). This difference remained significant after adjusting for covariates affecting the decision for mechanical ventilation, including year of the procedure, age and weight of subject, cardiopulmonary bypass time, the use of deep hypothermic circulatory arrest, intraoperative fentanyl dose, and the Risk Adjustment for Congenital Heart Surgery Score 1 (p = 0.0317). The odds of receiving mechanical ventilation are estimated to be two times higher for patients who did not receive dexmedetomidine than for patients who received dexmedetomidine after adjusting for variables.

CONCLUSION: The use of dexmedetomidine bolus in the operating room at the time of sternal closure in infants undergoing open heart surgery is associated with reduced need for mechanical ventilation in the immediate postoperative period.

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