Efficacy of Dexmedetomidine With High-Flow Nasal Cannula Therapy in Children With Respiratory Distress: A Retrospective Case Series

Background High-flow nasal cannulae (HFNC) are increasingly used in the management of respiratory distress in children. In pediatric patients, intubation should be considered if HFNC or noninvasive ventilation fails to improve respiratory status. Intubation is also indicated in the presence of upper airway obstruction or a sudden decline in consciousness. Dexmedetomidine (DEX), a sedative agent that can be administered without compromising spontaneous respiration, has recently gained attention. Research on DEX use under non-invasive ventilation (NIV) is increasing; however, data regarding the efficacy of combining HFNC with DEX are limited. We hypothesized that adding DEX to HFNC would reduce signs of respiratory distress in children and decrease the intubation rate. Methods This single-center, retrospective case series was conducted at Showa University Hospital. Patients admitted to the intensive care unit (ICU) between April 1, 2021, and August 31, 2023, with respiratory distress and managed with both HFNC and DEX were included. No comparator HFNC-alone group was available. The primary outcome was respiratory rate, assessed at 3 and 12 h after the initiation of DEX administration. Results Thirteen patients were included. The median age was nine (3-28) months, and respiratory syncytial virus was the cause in eight cases. The median respiratory rate upon ICU admission was 60 (56-64) breaths/min. At 3 and 12 h after treatment initiation, respiratory rates significantly decreased to 41 (31-52) and 40 (36-50) breaths/min, respectively (p<0.05). Conclusions Combining DEX with HFNC may reduce respiratory distress and help prevent the need for tracheal intubation in pediatric patients.