Acute and Critical Care

Original Articles

Pharmacology
Dexmedetomidine Use in Patients with 33℃ Targeted Temperature Management: Focus on Bradycardia as an Adverse Effect: Hyo-yeon Seo, Byoung-joon Oh, Eun-jung Park, Young-gi Min, Sang-cheon Choi; Korean J Crit Care Med. 2015;30(4):272-279. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.272

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Abstract PDF: Background
This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33℃ target temperature management.
Methods
A retrospective study was conducted on patients who underwent 33℃ target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia.
Results
A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 ± 0.15 μg/kg/h. Decisions of charged doctor’s were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole.
Conclusions
Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33℃ target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33℃ targeted temperature management.

Cardiology/Pediatric
Effectiveness of Bradycardia as a Single Parameter in the Pediatric Acute Response System: Yu Hyeon Choi, Hyeon Seung Lee, Bong Jin Lee, Dong In Suh, June Dong Park; Korean J Crit Care Med. 2014;29(4):297-303. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.297

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3 Crossref

BACKGROUND
Various tools for the acute response system (ARS) predict and prevent acute deterioration in pediatric patients. However, detailed criteria have not been clarified. Thus we evaluated the effectiveness of bradycardia as a single parameter in pediatric ARS.
METHODS
This retrospective study included patients who had visited a tertiary care children's hospital from January 2012 to June 2013, in whom ARS was activated because of bradycardia. Patient's medical records were reviewed for clinical characteristics, cardiologic evaluations, and reversible causes that affect heart rate.
RESULTS
Of 271 cases, 261 (96%) had ARS activation by bradycardia alone with favorable outcomes. Evaluations and interventions were performed in 165 (64.5%) and 13 cases (6.6%) respectively. All patients in whom ARS was activated owing to bradycardia and another criteria underwent evaluation, unlike those with bradycardia alone (100.0% vs. 63.2%, p = 0.016). Electrocardiograms were evaluated in 233 (86%) cases: arrhythmias were due to borderline QT prolongation and atrioventricular block (1st and 2nd-degree) in 25 cases (9.2%). Bradycardia-related causes were reversible in 202 patients (74.5%). Specific causes were different in departments at admission. Patients admitted to the hemato-oncology department required ARS activation during the night (69.3%, p = 0.03), those to the endocrinology department required ARS activation because of medication (72.4%, p < 0.001), and those to the gastroenterology department had low body mass indexes (32%, p = 0.01).
CONCLUSIONS
Using bradycardia alone in pediatric ARS is not useful, because of its low specificity and poor predictive ability for deterioration. However, bradycardia can be applied to ARS concurrently with other parameters.

Citations

Citations to this article as recorded by

Effect of Diurnal Variation of Heart Rate and Respiratory Rate on Activation of Rapid Response System and Clinical Outcome in Hospitalized Children
Lia Kim, Kyoung Sung Yun, June Dong Park, Bongjin Lee
Children.2023; 10(1): 167. CrossRef
Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea
Yong Hyuk Jeon, Bongjin Lee, You Sun Kim, Won Jin Jang, June Dong Park
Acute and Critical Care.2023; 38(4): 498. CrossRef
Pediatric triage modifications based on vital signs: a nationwide study
Bongjin Lee, June Dong Park, Young Ho Kwak, Do Kyun Kim
Clinical and Experimental Emergency Medicine.2022; 9(3): 224. CrossRef

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