Dexmedetomidine Versus Midazolam as a Primary Sedative Agent in Critically Ill Pediatrics

Background: Dexmedetomidine is recommended for postoperative sedation in critically ill pediatric patients after cardiac surgery with anticipated early extubation. There is inadequate national guidelines on its use as a primary sedation agent in the pediatric intensive care unit (PICU). Objective: The purpose of this study was to compare the efficacy and safety of dexmedetomidine versus midazolam in pediatric patients. Methods: This single-center retrospective chart review included children aged 1 month to 14 years admitted to the PICU at a quaternary hospital in Saudi Arabia who were mechanically ventilated and received either dexmedetomidine or midazolam as their primary sedative. The primary objectives were PICU length of stay and duration of mechanical ventilation. Secondary objectives included the requirement for additional sedative and analgesic agents, achievement of sedation goal based on the Sedation Behavioral Scale (SBS) and COMFORT scale, and the occurrence of hypotension, bradycardia, or arrhythmia. Results: A total of 190 patients were included, 38 patients received dexmedetomidine and 152 received midazolam. The mean PICU length of stay was 13.97 ± 14.96 days for the dexmedetomidine group and 11.92 ± 12.68 days for the midazolam group ( P = 0.39). Mechanical ventilation (MV) duration was 8.35 ± 14.33 days and 6.10 ± 8.44 days, respectively ( P = 0.36). Patients in the midazolam group required more additional sedatives/analgesics, while sedation goal achievement was higher but not statistically significant. No differences in safety outcomes were noted, including cardiac arrhythmias, bradycardia, or hypotension. Conclusion and Relevance: Dexmedetomidine and midazolam showed comparable efficacy and safety outcomes indicating no advantage of one agent over the other. Dexmedetomidine can be considered an alternative to midazolam when minimizing additional sedative and opioid exposure is desired.