PURPOSE: The goal of this study was to evaluate the safety and efficacy of a 24 hour Dexmedetomidine (DEX) sedation protocol in PICU patients preparing for extubation. Our secondary aims were to determine if any correlations existed between patients that exhibited complications, and to characterize the timing of complications that occurred.
METHODS: A retrospective case-control chart review was performed on patients who received DEX in the PICU between September 2009 and March 2010. Each DEX patient was matched with a control patient based on age and on opioid and benzodiazepine use, adjusted for weight, cumulative dose, and duration of exposure. Mann-Whitney U-test was performed to measure differences in outcomes and complications between groups. Repeated measures ANOVA was performed to measure differences between mean heart rate and blood pressure for six hours following the initiation of DEX.
RESULTS: The study population consisted of 36 patients on DEX and 32 matched controls. No significant difference was found in mortality, LOS, ventilator days, or extubation success between groups. Among the patients who received DEX, 4 out of 36 (11%) developed hypotension requiring intervention. Patients on DEX who developed hypotension were more likely to have elevated serum creatinine values compared to patients who did not develop hypotension [OR=31, p=0.05]. In patients who developed hypotension while on DEX, systolic BP fell from baseline an average of 15 mmHg during the second hour of infusion and an average of 30 mmHg during the third hour of infusion (p < 0.01 for each).
CONCLUSIONS: A protocol allowing use of DEX for 24 hours did not significantly reduce duration of hospital LOS, mechanical ventilation or ventilation free days. Hypotension occurred frequently (11%) in patients receiving DEX, occurring more commonly in patients with elevated creatinine. Hypotension was most profound 2-4 hours after the initiation of DEX.
CLINICAL IMPLICATIONS: Hypotension with DEX is common; caution should be used in the PICU population, especially in patients with comorbidities such as renal dysfunction.
DISCLOSURE: The following authors have nothing to disclose: Kevin Roy, Erin McDade, Esther Soundar, Curtis Kennedy
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