Critical Care: Original Investigations in Critical Care |

Outcomes of Obese Patients on Dexmedetomidine in the Critical Care FREE TO VIEW

Aasim Mohammed; Ana Maheshwari, MD; Stephenie Manns, MD
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Mercy Catholic Medical Center, Yeadon, PA

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

Chest. 2016;150(4_S):346A. doi:10.1016/j.chest.2016.08.359
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SESSION TITLE: Original Investigations in Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 04:30 PM - 05:30 PM

PURPOSE: Obesity is a worldwide healthcare concern, and its impact on critical care outcomes is not well understood. In general, obesity is thought to worsen Intensive care unit (ICU) outcomes, but published reports fail to demonstrate this effect consistently. We hypothesize that increased body mass index (BMI) is an independent predictor of ICU outcomes on patients with Dexmedetomidine (DEX) infusions. We studied characteristics and outcomes of obese patients on DEX in the ICU compared to non-obese patients.

METHODS: A retrospective observational study in adult ICUs at two urban academic community hospitals was conducted between January 2014 to September 2015. All medical and surgical ICU patients older than 18 years old were included. Patients were excluded if DEX was used for procedural purposes only. All patients on a DEX infusion (197) were studied; 47 patients were excluded due to incomplete documentation and final analysis was done on 150 patients. Patients were classified into groups based on the calculated BMI, as follows: BMI < 29.9 (NON-OBESE) and BMI ≥ 30.0 (OBESE). Groups were analyzed for APACHE (acute physiology and chronic health evaluation) II score, ICU length of stay (LOS), hospital LOS, ventilator-days, and mortality. Duration of infusion and side effects were examined for both groups.

RESULTS: The severity of illness, assessed by APACHE II scores, was similar between the OBESE group (26.6, n=54) and NON-OBESE group (24.7, n=96). There were no differences in ICU LOS (12 days vs 10.5 days, p-value=0.29), hospital LOS (15.3 days vs 16.2 days, p-value=0.68), ventilator-days (8.9 days vs 7.0 days, p-value=0.15) and total hours on DEX infusion (44 hours vs 40 hours, p-value=0.56) among the OBESE AND NON-OBESE groups. There was a low incidence of bradycardia (22%) in OBESE group compared to NON-OBESE group (39%) which was statistically significant (p-value=0.03). The average dose at which the bradycardia occurred in both the groups was 0.7 mcg/kg/hr. The incidence of hypotension (OBESE 40% vs NONOBESE 35%, p-value=0.59) was similar between the two groups. Mortality in the OBESE group was 15%(n=8) compared to 7%(n=7) in the NON-OBESE group.

CONCLUSIONS: In our study, the OBESE group had similar severity of illness compared to the NON-OBESE group, as evidenced by their APACHE II scores. Interestingly, the incidence of bradycardia was significantly lower in the OBESE group as compared to NON-OBESE group despite the same average dose. The lower incidence of bradycardia is likely explained by the linear relationship between DEX clearance and increasing body weight, hence lower plasma concentration of DEX in OBESE group. We observed comparable incidences of hypotension in these groups. The ICU LOS, ventilator days, hospital LOS and duration on DEX infusion were similar in the OBESE group compared to NON-OBESE group. In conclusion, the OBESE group tolerated DEX infusions with less incidence of bradycardia, and tolerated the infusion as well as the NON-OBESE group.

CLINICAL IMPLICATIONS: Since obese patients tolerate Dexmedetomidine infusions better than non obese patients, Dexmedetomidine can be considered as a viable option for sedation in this group. Studies using larger populations are needed to confirm these observations.

DISCLOSURE: The following authors have nothing to disclose: Aasim Mohammed, Ana Maheshwari, Stephenie Manns

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