Sedation with dexmedetomidine in the intensive care setting

Gerlach, Anthony T.; Murphy, Claire V.

doi:10.2147/oaem.s17429

Cited by 10 publications

(24 citation statements)

References 41 publications

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“…[ 4 5 ] Based on these characteristics, dexmedetomidine use has been increasing in the critical care setting, and this trend has been further augmented by recurring propofol shortages. [ 6 ]…”

Section: Introductionmentioning

confidence: 99%

Predictors of dexmedetomidine-associated hypotension in critically ill patients

Gerlach

Blais

Jones

et al. 2016

Int J Crit Illn Inj Sci

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Background:Dexmedetomidine is commonly used for sedation in the Intensive Care Unit (ICU), and its use may be associated with hypotension. We sought to determine predictors of dexmedetomidine-associated hypotension.Methods:Retrospective, single-center study of 283 ICU patients in four adults ICUs over a 12 month period. Univariate analyses were performed to determine factors associated with dexmedetomidine-related hypotension. Risk factors significant at the 0.20 level in the univariate analysis were considered for inclusion into a step-wise multiple logistical regression model.Results:Hypotension occurred in 121 (42.8%) patients with a median mean arterial pressure (MAP) nadir of 54 mmHg. Univariate analyses showed an association between hypotension and age (P = 0.03), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (P = 0.02), baseline MAP (<0.001), admission to the cardiothoracic ICU (P = 0.05), history of coronary artery disease (P = 0.02), and postcardiac surgery (P = 0.0009). Admission to the medical ICU was associated with a decrease in development in hypotension (P = 0.03). There was a trend for hypotension with weight (P = 0.09) and history of congestive heart failure (P = 0.12) Only MAP prior to initiation (odds ratio [OR] 0.97, 95% confidence interval [95% CI] 0.95–0.99; P < 0.0001), APACHE II scores (OR 1.06, 95% CI 1.01–1.12; P = 0.017), and history of coronary artery disease (OR 0.48, 95% CI 0.26–0.90, P = 0.022) were independently associated with hypotension by multivariable analysis.Conclusions:Dexmedetomidine-associated hypotension is common. Preexisting low blood pressure, history of coronary artery disease, and higher acuity were identified as independent risk factors for dexmedetomidine-associated hypotension.

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Section: Introductionmentioning

confidence: 99%

Predictors of dexmedetomidine-associated hypotension in critically ill patients

Gerlach

Blais

Jones

et al. 2016

Int J Crit Illn Inj Sci

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“…Manufacturer recommendations state that dexmedetomidine use for sedation should not exceed 24 h . However, the data presented herein show considerable variability, with median duration of therapy ranging from 24 to 84 h. In non‐Australian sites, the duration of therapy has reportedly ranged from 1 h (for aiding extubation) to up to 30 days (for sedation) …”

Section: Discussionmentioning

confidence: 88%

“…Previous studies indicate that prescribed maintenance doses often depend on the indication and clinician preference, with maintenance doses as low as 0.15 microgram/kg per h and as high as 2.5 microgram/kg per h reported in the literature . There appears to be no consensus on how to initiate or titrate dexmedetomidine outside of manufacturer recommendations …”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine prescribing in Australian intensive care units: an observational study

O’Brien

Cotta

Choo

et al. 2019

Pharmacy Practice and Res

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Dexmedetomidine is used in the intensive care unit (ICU) as a short‐term sedative. The data included in the manufacturer's product information is controversial, and there is little consensus to guide initial dosing and titration. This observational study surveyed the practice of dexmedetomidine use in Australian ICUs. An expression of interest (EOI) for a multisite observational study was sent to members of the ICU email group of the Society of Hospital Pharmacists Australia (SHPA). Participating members collected treatment‐related data for patients meeting inclusion criteria between January 2013 and July 2014. Six of 14 sites that responded positively to the EOI returned complete datasets, and 232 patients met the inclusion criteria. The main reported indications for dexmedetomidine use across the six sites were to manage agitation (33.2%), to aid extubation (32.8%) and to sedate (34.0%). The median duration of therapy was 42 h (range 1–672 h). Only nine patients (3.9%) received loading doses. The median maximum dose used for maintenance therapy in patients ranged from 1.2 to 4.0 microgram/kg per h. There was a significant disparity of practice across sites, as evidenced by differences in reported indication, off‐label use, rates of loading doses and doses used for maintenance therapy. Consensus prescribing guidelines are required to guide more consistent and evidence‐based prescribing of dexmedetomidine.

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“…We based the sample size calculation on an estimated time within therapeutic target of 64% in patients without morbid obesity. 9 An estimation was made that patients with morbid obesity would be in therapeutic range 40% of the time. Per this sample size calculation, 134 patients would need to be enrolled to meet 80% power, with an alpha of 0.05.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Sedation Targets With Weight-Based Propofol and Dexmedetomidine in Patients With Morbid Obesity

Hayes

Esteves

2022

Ann Pharmacother

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Background: Propofol and dexmedetomidine are routinely used in intensive care units (ICUs). Both are lipophilic, potentially leading to accumulation in adipose tissue. Limited evidence exists on what body weight to utilize in patients with morbid obesity. Objective: The purpose of this research was to evaluate the safety and efficacy of weight-based sedation with propofol and dexmedetomidine in ICU patients with morbid obesity. Methods: Retrospective review of ICU patients admitted from January 2018 to January 2020 who were sedated for ≥48 hours was performed. The primary outcome was the percentage of time within target sedation during the first 48 hours, stratified by body mass index (BMI) <40 or ≥40 kg/m2. Additional outcomes included adverse events and the infusion rate to achieve target sedation. Data were evaluated using descriptive statistics. Results: A total of 80 patients were analyzed. Patients on propofol with a BMI <40 kg/m2 were in their target Richmond Agitation-Sedation Scale (RASS) 11.7% versus 16.1% with a BMI ≥40 kg/m2 ( P = .580). Patients with a BMI <40 kg/m2 on dexmedetomidine were in their target RASS 27.6% versus 10.7% with a BMI ≥40 kg/m2 ( P = .053). Conclusion and Relevance: Body mass index did not significantly alter propofol target sedation attainment. However, patients with morbid obesity on dexmedetomidine demonstrated significantly less time in target sedation. An actual body weight dosing strategy of these drugs did not achieve desired target sedation for those with a BMI ≥40 versus BMI <40 kg/m2. These findings support future research on the optimal sedation dosing strategy in this patient population.

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Sedation with dexmedetomidine in the intensive care setting

Cited by 10 publications

References 41 publications

Predictors of dexmedetomidine-associated hypotension in critically ill patients

Predictors of dexmedetomidine-associated hypotension in critically ill patients

Dexmedetomidine prescribing in Australian intensive care units: an observational study

Adherence to Sedation Targets With Weight-Based Propofol and Dexmedetomidine in Patients With Morbid Obesity

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