Dexmedetomidine (DX) has three main clinical uses: prolonged sedation in ... dexmedetomidine controlled symptoms, specially agitation and delirium,.
Clinical uses of dexmedetomidine in a tertiary university hospital ICU Fariña González T.F., Jiménez Martín M.J., Pardo Rey C., Del Pino A., García Alonso L., Sanchez García M. Department of Intensive Care, Hospital Universitario Clínico San Carlos, Madrid, Spain
BACKGROUND: •
Dexmedetomidine (DX) has three main clinical uses: prolonged sedation in hospitalized patients, procedural sedation and general anaesthesia. Another important setting is to control agitation during mechanical ventilation weaning.
AIM:
To describe the use of dexmedetomidine and a sedation protocol in a multipurpose tertiary university hospital ICU
MATERIALS AND METHODS: • •
Retrospective audit in a 40-bed ICU Patients admitted between May 2013 to April 2016 that received DX during their stay in the ICU.
Variables recorded: • Demographics • Motive of ICU admission • Indication of DX use • Use of other sedative or analgesic drugs (propofol, midazolam, remifentanyl or
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•
fentanyl and haloperidol DX effectiveness • Agitation control • Reduction of other drugs dosage Interruption due to AE
RESULTS: • 8057 patients were admitted in the ICU; only 57 (0,7%) were treated with DX and were analyzed. Age Male sex
61 (SD 13.42) 66.7%
Mortality
24.6%
Propofol
80.7%
Remifentanyl of fentanyl 54.4% Morphine chloride
8.9%
Haloperidol
9 (15.8%)
DX Minimum dose
0.47 ug/kg/h (IQR 0.27-0.66)
DX Maximum dose
1 ug/kg/h (IQR 0,7-1.4)
LOS ICU
17 days (IQR 9-36)
LOS Hospital
35 days (IQR 19-51)
Mortality
24,6%
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• •
DX controlled agitation in 43 patients (75.4%). Previous analgesic/sedative drugs could be reduced or suspended in the 66.7% (n=38). No association between effectiveness and mortality was found when analyzing: • agitation control (p=0.51) • drugs reduction (p=0.33). 11 patients (19,29%) were treated in more than one occasion. In those patients median duration was 5 days (IQR 3-11). In 4 cases (7%), DX was discontinued because of adverse events (bradycardia or atrioventricular block).
CONCLUSIONS: • Although underused, dexmedetomidine controlled symptoms, specially agitation and delirium, and helped to reduced others drugs with minimum side effects.
