Original Research
Saturday, October 12, 2024
11:30 AM–01:00 PM
Abstract
Introduction: There is limited literature exploring the efficacy and safety of dexmedetomidine and propofol in the critically ill mechanically ventilated oncology population. Patients with an underlying malignancy may benefit from the analgesic properties of dexmedetomidine, optimizing analgesia and sedation.
Research Question or Hypothesis: Does dexmedetomidine (D group) for mechanically ventilated (= 24 hours) adult patients with malignancies improve time at target sedation (TTS) when compared to propofol (P group) or the combination of propofol and dexmedetomidine (P&D group)?
Study Design: Retrospective, single center, cohort study.
Methods: The primary outcome was the percentage of time RASS scores was within goal (TTS). Continuous outcomes were examined using Kruskal-Wallis and Wilcoxon rank-sum tests. Fisher's exact test and logistic regression were used to compare categorical outcomes. A post-hoc secondary analysis of two groups was conducted by reassigning the P&D patients to either the P or D group based on longer infusion time.
Results: A total of 113 patients were included (P group: n=94, D group: n=12, P&D group: n=7). The median TTS was 29.7% in the P group, 24.2% in the D group, and 32.3% in the P&D group (p=0.7492). More patients in the P&D group (71.5%) and the P group (55.3%) required the use of as needed propofol, compared to the D group (16.7%). The MDD of as needed fentanyl was significantly higher in the P&D group (125mcg/day, IQR 92.5-165) compared to the P (75mcg/day, IQR 50-100) and D group (50mcg/day, IQR 50-61.9) (p=0.0136). There was no statistically significant difference in all other secondary outcomes. The secondary analysis (P group: n=99; D group: n=14) found more hypotension (92.9% vs 63.6%; p =0.0334) and vasopressor use (100% vs 73.7%; p =0.0372 ) in the D group.
Conclusion: Dexmedetomidine for mechanically ventilated patients with malignancies did not result in a difference in TTS compared to propofol or the combination.
Presenting Author
Aisha Siddique BSc, PharmDRoswell Park Comprehensive Cancer Center
Authors
Christina Candeloro PharmD
Roswell Park Comprehensive Cancer Center
Aubrey Defayette PharmD
Roswell Park Comprehensive Cancer Center
Ananda Dharshan MD
Roswell Park Comprehensive Cancer Center
Mengyu Fang MS
Roswell Park Comprehensive Cancer Center
Brian Ho PharmD
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Amy Thoby PharmD
Roswell Park Comprehensive Cancer Center
Han Yu PhD Biostatistics
Roswell Park Comprehensive Cancer Center