Critical Care: Mechanical Ventilation & Respiratory Failure II |

Efficacy and Safety of Dexmedetomidine in Facilitating Extubation in Mechanically Ventilated Patients FREE TO VIEW

Kevin Dsouza, MD; Mindee Hite, PharmD; Laurie Lerner, MD
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Rochester General Hospital, Rochester, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):321A. doi:10.1016/j.chest.2016.08.334
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SESSION TITLE: Mechanical Ventilation & Respiratory Failure II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Dexmedetomidine (DEX), a selective alpha-2-adrenergic receptor agonist, possesses sedative, analgesic and anxiolytic properties without causing significant respiratory depression in mechanically ventilated (MV) patients. In MV patients who are difficult to wean off of sedation secondary to agitation, DEX may be able to shorten time to extubation. The purpose of this study is to assess the percentage of MV patients deemed difficult to extubate secondary to agitation that were successfully extubated within 48 hours after initiation of DEX therapy.

METHODS: A single-center retrospective observational analysis of adult intubated patients who received DEX to facilitate extubation in the Medical Intensive Care Unit (MICU). DEX was dosed by protocol via a continuous infusion at 0.4-1.5 mcg/kg/hour without bolus dosing. The primary outcomes were the percentage of extubated patients within 48 hours and the incidence of hypotension (systolic blood pressure below 90 mmHg) and bradycardia (heart rate less than 55 beats per minute) when DEX was added to therapy to facilitate extubation. Patient parameters were collected and results were analyzed using descriptive statistics. All data was expressed as median [interquartile range] or number (percentage).

RESULTS: Thirty-two patients received DEX to facilitate extubation. Twenty-six (81.3%) patients were successful extubated within 48 hours of starting DEX. The duration of DEX therapy was 21.7 hours [6.3-23.9] in patients who were successfully extubated within 48 hours. The initial DEX dose was 0.4 mcg/kg/hr for all patients while the maximum DEX dose was 0.7 mcg/kg/hr [0.5-1.1]. Bradycardia occurred in 6 patients (18.8%) whereas hypotension occurred in 7 patients (21.9%). One patient required discontinuation of dexmedetomidine secondary to hypotension.

CONCLUSIONS: This study suggests that the addition of DEX therapy in adult MV MICU patients was associated with successful extubation within 48 hours of initiating therapy. DEX was associated with a high rate of bradycardia and hypotension; therefore, close monitoring should occur during DEX administration.

CLINICAL IMPLICATIONS: Maximal benefit of DEX in the facilitation of extubation is noted within 48 hours after initiation

DISCLOSURE: The following authors have nothing to disclose: Kevin Dsouza, Mindee Hite, Laurie Lerner

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