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Dexmedetomidine for sedation during hematopoietic stem cell harvest apheresis and leukapheresis in the PICU: Guideline development

      Abstract

      Background

      Hematopoietic stem cell (HSC) harvest apheresis and leukapheresis are performed in the pediatric intensive care unit (PICU) for high-risk pediatric patients who require procedural sedation. Patients need central access either with their own central lines, ports or require apheresis catheter (CVL) placement. Previously, patients were either awake or emerging from sedation on PICU admission. Uncertainty regarding procedural sedation plans caused delays initiating sedation and apheresis. A guideline was developed to standardize Dexmedetomidine (DEX) for procedural sedation. We investigated if guideline implementation would improve efficiency during PICU admission as demonstrated by shorter time intervals for initiation of sedation, apheresis, PICU length of stay and less alternative sedating medication.

      Methods

      Data was collected retrospectively from electronic health records of preguideline and post-guideline patients who were admitted to the PICU for sedated apheresis. We compared demographic and clinical characteristics, time intervals for sedation, apheresis, PICU length of stay, and sedation agents between the two groups using Fisher Exact tests and Mann-Whitney tests, as appropriate.

      Results

      The groups did not differ in age or weight at the time of apheresis. All intervals of time compared were shorter post-guideline. Time intervals from admission to start of sedation, admission to start of apheresis, and admission to end of apheresis were statistically significantly different. The type and number of alternative sedating medications administered did not differ between the two groups.

      Conclusion

      This guideline implementation improved efficiency during PICU admission. This study might have been too small to demonstrate statistically significant differences in other time intervals studied.

      Abbreviations:

      AC (anticoagulant), ACD-A (anticoagulant citrate dextrose solution, solution A), apheresis (harvest apheresis), BCT (Blood and Cell Technologies), BMT (Bone Marrow Transplant), CAR-T (chimeric antigen receptor T cell), CC (critical care), cMNC (continuous mononuclear cell), CVL (apheresis catheter), DEX (Dexmedetomidine), FLACC (Face, Legs, Activity, Cry, Consolability Behavior Scale), HSC (hematopoietic stem cell), IR (Interventional Radiology), L (Liter), µL (microliters), mL (milliliters), min (minute), MNC (mononuclear cell), PICU (Pediatric Intensive Care Unit), Post (post-guideline), Pre (pre-guideline), PRN (as needed), RASS (Richmond Agitation-Sedation Scale), tPA (tissue plasminogen activator), WBC (white blood cells)

      Keywords

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