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Effect of Dexmedetomidine In Children with Trisomy 21 Undergoing Congenital Heart Surgery

Sunday, October 21, 2012: 9:15 AM
Room 210 (Morial Convention Center)
Antonio G. Cabrera, MD, David Morales, MD, Gerald Adams, PhD, Emad Mossad, MD and Brady Moffett, PharmD, Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine - Texas Children's Hospital, Houston, TX

Purpose

Dexmedetomidine (DEX) is a novel sedative agent with minimal respiratory depressive effects.  The use of DEX in post-operative pediatric cardiac surgical patients may improve outcomes.  Patients with Trisomy 21 that have undergone cardiac surgery can be difficult to sedate and extubate.  DEX may be a useful agent to improve post-operative outcomes. The purpose of our study was to assess the outcomes of children with Down syndrome treated with DEX as adjunct sedation after congenital heart surgery.

Methods

A retrospective case matched study was conducted using the Pediatric Health Information System (PHIS) database from 2009-2010 for all patients with Trisomy 21 (ICD-9 code 758.0) who underwent a cardiac surgical procedure.  Patients who received DEX were matched to patients who did not received DEX by propensity score matching by age, gender, and RACHS-1 score.  Patients were excluded if they did not have a match, received extracorporeal membrane oxygenation or ventricular assist device, had an open sternum in the ICU, or had missing data. A sample of approximately 500 patients per group was estimated to detect approximately a 20% difference in the primary outcome of ventilator days.

Results

1,434 patients met study criteria and propensity score matching resulted in 356 matched pairs (712 patients).  Baseline characteristics were similar between the two groups with the exceptions of increased dopamine use in the non-DEX group and increased vasopressin use in the DEX group (p<0.05).  Patients in the DEX group received DEX for a median of 8 days (Range 3-166 days).  Proportionally more patients in the DEX group received morphine, lorazepam and ketorolac and fewer patients received fentanyl or midazolam (p<0.05).  There was no difference in ventilator days (6.5 (1-535) vs. 7 (1-165), p =0.07) in DEX and non-DEX groups, and no difference in ICU length of stay (4 (0-127) vs. 4 (0-166), p=0.94), hospital length of stay (6 (2-534) vs.7 (2-165), p=0.33), mortality (0.28% vs. 0.84%, p=0.32) or incidence of bradyarrythmias (11.2% vs 10.7%, p=0.81).

Conclusion

Use of DEX does not improve outcomes in patients with Trisomy 21 who have undergone surgery for congenital heart disease