Dexmedetomidine Use in Children With Acute Bronchiolitis Requiring High-Flow Nasal Cannula

Introduction: Dexmedetomidine (DEX) use in children receiving noninvasive ventilation such as BiPAP and CPAP has been reported to be effective for achieving patient tolerance of the interface. DEX use in HFNC has not been described though it is anecdotally used with the thought that it helps alleviate anxiety and agitation impeding effective respiratory effort. Our primary aim was to describe the use of DEX in children with bronchiolitis requiring HFNC. Our secondary objective was to compare characteristics and outcomes between patients who received DEX to those that did not.


Methods: We performed a single center, retrospective cohort study using the Virtual Pediatric Systems (VPS) database from 2018-2024. All patients admitted to our pediatric intensive care unit with a diagnosis of bronchiolitis and requiring the use of HFNC were included. Univariate analyses were performed to compare characteristics and outcomes between patients who received DEX and those that did not. Significant factors identified in the univariate analyses were used in multivariate analyses to confirm the independent associations with the use of DEX.


Results: Among 1,756 children admitted to the PICU with bronchiolitis, 699 (39.8%) received DEX. The DEX group had a higher proportion of male patients (63.3% vs. 55.5%, p=0.002) and more frequent diagnoses of bronchiolitis due to RSV (70.3% vs. 44.8%, p< 0.001). PRISM III risk of mortality was slightly higher in the DEX group (median 0.56 vs. 0.51, p< 0.001). Use of DEX was associated with increased rate of escalation from HFNC to NIPPV (6.3% vs. 3.5%, p=0.01) and from HFNC to IMV (7.4% vs. 4.3%, p=0.02). PICU length of stay was slightly longer in the DEX group (median 2.51 vs. 2.13 days, p< 0.001), though hospital LOS was not significantly different. Logistic regression adjusting for age, sex, and PRISM III risk of mortality showed that DEX use was associated with increased odds of escalation from HFNC to NIPPV (adjusted OR 1.77, 95% CI 1.10–2.85), and from HFNC to IMV (adjusted OR 1.77, 95% CI 1.15–2.74).


Conclusions: Our findings show that DEX use was associated with increased escalation of respiratory support. Future work, including multicenter analyses, is necessary to further characterize the role of DEX in escalation of respiratory support in children with bronchiolitis.