PURPOSE: Dexmedetomidine (Dex) is an alpha-2 adrenoreceptor agonist which has been introduced as an agent for sedation of the critically ill. Dex provides sedation, anxiolysis, analgesia, and attenuation of the stress response. In the SEDCOM study, Dex was associated with less time on the ventilator, less delirium, less tachycardia, and less hypertension than midazolam. We tested the hypothesis that the use of Dex in routine ICU care, outside of a randomized trial, is also associated with reduced ventilator days and length of stay (LOS).
METHODS: Retrospective analysis for 4/1/2010-3/31/2011 performed by query of the University Healthcare Consortium (UHC) pharmacy database to determine ventilator days, ICU LOS, and hospital LOS in patients with acute respiratory failure (DRG 207) who received Dex and patients who received other sedative agents (OS). Statistical analysis by Student’s t test.
RESULTS: There were 3,414 patients in DRG 207. Of these, 387 (11.8%) received Dex and 3,027(88.2%)received OS. Ventilator days were 10 in the Dex group and 8.5 in the OS group. ICU LOS was 12.99 days in the Dex group and 11.23 days in the OS group. Hospital LOS was 18.74 days in the Dex group and 15.89 days in the OS group. Severity of illness was not different between the groups.
CONCLUSIONS: Our findings demonstrate that Dex in sedation of critically ill mechanically ventilated patients in academic medical centers was associated with increased ventilator days, increased ICU LOS, and increased hospital LOS, compared with other sedative agents.
CLINICAL IMPLICATIONS: These findings differ from previous randomized, controlled studies, and suggest that dexmedetomidine should be used for reasons other than shortening ventilator days.
DISCLOSURE: The following authors have nothing to disclose: Amanda Gudgell, Brian O'Neal, Rick Couldry, Steven Simpson
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