ICU sedation with dexmedetomidine after severe traumatic brain injury

Abstract

Objective To comprehensively describe the use of dexmedetomidine in a single institutional series of adult ICU patients with severe TBI. We describe the dexmedetomidine dosage and infusion times, as well as the physiological parameters, neurological status, and daily narcotic requirements before, during, and after dexmedetomidine infusion. Methods We identified 85 adult patients with severe TBI who received dexmedetomidine infusions in the Trauma ICU at Vanderbilt University Medical Center between 2006 and 2010. Demographic, hemodynamic, narcotic use, and sedative use data were systematically obtained from the medical record and analyzed for changes associated with dexmedetomidine infusion. Results During infusion with dexmedetomidine, narcotic and sedative use decreased significantly (p<.001 and p<.05). Median MAP, SBP, DBP, and HR also decreased significantly during infusion when compared to pre-infusion values (p<.001). Despite the use of dexmedetomidine, RASS and GCS scores improved from pre-infusion to infusion time periods. Conclusions Our findings demonstrate that initiation of dexmedetomidine infusion is not associated with a decline in neurological functioning in adults with severe TBI. Although there was an observed decrease in hemodynamic parameters during infusion with dexmedetomidine, the change was not clinically significant, and the requirements for narcotics and additional sedatives were minimized.

Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury

“…Widely used in the intensive care unit to alleviate pain and anxiety, maintain the stability of hemodynamics, with less respiratory depression without requirement for mechanical ventilation, easy to wake patients up to judge the consciousness state, can be used as a preventive drug for PSH in TBI patients (66,80,81).…”

Dexmedetomidine attenuates acute paroxysmal sympathetic hyperactivity

“…Through its action on the α2 receptor in the spinal cord, dexmedetomidine can produce an analgesic effect and lead to the sedation and anxiety remission. It is a strong sedative and does not affect the patient’s sense of judgment, making dexmedetomidine an ideal sedative for patients with severe craniocerebral injury in perioperative period [ 19 ].…”

Resuscitation Strategies for Traumatic Brain Injury

“…While not as extensively studied as beta-blockers in TBI, proponents of the LC point to multiple preclinical TBI studies that showed neuroprotective effects and decreases in plasma catecholamine levels with the use of alpha-2 agonists [56,57]. Furthermore, there is recent clinical evidence that dexmedetomidine is safe in patients with severe TBI and may decrease requirements for narcotics and additional sedatives [58].…”