Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction:
Dexmedetomidine has been shown to impact hemodynamic stability during its use in mechanically ventilated patients. However, those findings are difficult to extrapolate in situations not involving invasive ventilation. There is an increased use of dexmedetomidine for agitation in non-ventilated patients, but data is limited regarding the safety and benefit in this population.
Research Question or Hypothesis: What is the incidence of hemodynamic compromise after dexmedetomidine initiation in non-mechanically ventilated patients?
Study Design: A retrospective, single cohort, IRB-approved, pre-post study.
Methods: Adult patients initiated on continuous intravenous dexmedetomidine outside of invasive mechanical ventilation were evaluated for inclusion. Data was collected from an electronic health record 24-hours prior to and 24-hours following dexmedetomidine initiation. The primary endpoint was a composite rate of hemodynamic compromise after dexmedetomidine initiation. Differences in outcomes between pre- and post-dexmedetomidine time periods were compared using McNemar’s test or Wilcoxon signed-rank test for nominal and continuous data, respectively.
Results: The study included 124 patients. Dexmedetomidine was initiated at a median dose of 0.2mcg/kg/hour (IQR 0.2-0.3) and continued for a median of 17.1 hours (IQR 6-41.1). There was a higher rate of hemodynamic compromise observed following dexmedetomidine initiation compared to the pre-dexmedetomidine time period (53.2 % vs 36.3%, P = 0.002). There was less benzodiazepine use (29.8% vs. 45.2%, p=0.001) but no difference in antipsychotic therapy (41.1% vs 35.5%, p=0.31) observed following dexmedetomidine initiation compared to the pre-initiation period. Patients experiencing hemodynamic compromise post-dexmedetomidine were associated with worse clinical outcomes compared to patients without hemodynamic compromise, with higher rates of invasive ventilatory support initiation (18.2% vs. 5.2%, p=0.027), ICU length of stay (median 7.3 vs. 4.7 days, p=0.047), and hospital length of stay (median 15 vs. 8.5 days, p=0.002).
Conclusion: When used in non-mechanically ventilated patients, dexmedetomidine significantly impacted hemodynamic stability. Further studies are warranted to determine the risks and benefits of employing dexmedetomidine in this population.
Presenting Author
Morgan Schenck PharmD CandidateUniversity of Nebraska Medical Center
Authors
Greg Peitz PharmD, BCCCP, FCCM
Nebraska Medicine