Evaluating the Use of Dexmedetomidine in Intubated and Non- intubated Patients in the Intensive Care Unit : A Retrospective Study in a Tertiary Hospital in Singapore
CCCF ePoster library. Wong H. Nov 1, 2016; 150954; 73 Disclosure(s): I have no disclosures.
Ms. Huanyan Wong
Ms. Huanyan Wong
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Topic: Retrospective or Prospective Cohort Study

Evaluating the Use of Dexmedetomidine in Intubated and Non- intubated Patients in the Intensive Care Unit : A Retrospective Study in a Tertiary Hospital in Singapore


Huanyan, Wong1; Yu- Lin, Wong2
1Department of Pharmacy, Tan Tock Seng Hospital, Singapore; 2Department of Anesthesiology and Intensive Care, Tan Tock Seng Hospital, Singapore



Abstract:

Introduction : Dexmedetomidine is an alpha-2- agonist with sedative, analgesic and opioid - sparing effects. It has been shown to be effective as a sedative in intubated and non- intubated patients, with a well- toleralability profile and low risk of respiratory depression. In our hospital, dexmedetomidine is used as a sedative in both intubated and non- intubated patients. Patients are often transited to dexmedetomidine from other sedatives in anticipation of extubation in intubated patients. 

Objectives : The primary purpose of this study is to evaluate and characterise the use of dexmedetomidine in intubated and non- intubated ICU patients, and to find out the safety and efficacy of dexmedetomidine.

Materials and methods: This was a retrospective study of patients sedated with dexmedetomidine in the adult Surgical and Neuro- ICU between January and December 2013. Primary objectives are the indication, dose, duration and weaning of dexmedetomidine. Secondary objectives are hypotension (SBP < 90mmHg), bradycardia (HR< 40 beats/ min), delirium and/ or agitation, and incidents of self extubation and removal of catheters and other medical devices. 

Results and discussion: A total 74 patients were evaluated. Dexmedetomidine was used for sedation in 27 (36.5%) non- intubated patients. Of the 47 (63.5%) intubated patients, 26 were sedated with demedetomidine and other sedatives, 17 patients were transited to dexmedetomidine from other sedatives for planned extubation and 4 were used as a sole sedative agent. A total of 14 (18.9%) patients were weaned off dexmedetomidine. No patients were given loading doses of dexmedetomidine. The average dose of dexmedetomidine was 0.35 ± 0.14 mcg/kg/hr. The lowest dose used was 0.23 ± 0.08 mcg/kg/hr and highest dose was 0.45 ± 0.18 mcg/kg/hr. Average duration of infusion was 49.4 ± 82.7 hours. There were 35 (47.3%) incidents of delirium and agitation, 5 (6.8%) patients experienced bradycardia and 16 (21.6%) patients experienced hypotension. There were 2 (2.7%) incidents of removal of medical devices secondary to agitiation and delirium. There was no statistical difference in all primary and secondary outcomes between the intubated and nontubated patients. In patients who were transited to dexmedetomidine in anticipation of extubation, all were successfully extubated without reintubation episodes. There were no cases of withdrawals from use of dexmedetomidine.

Conclusion(s): Dexmedetomidine is used in both intubated and non- intubated patients without significant differences in dosing regimens and side effects. Although not statistically significant, hypotension is more likely to occur when dexmedetomidine is used with other sedatives. The practice of weaning dexmedetomidine is non- standardised in the institution. Transiting patients to dexmedetomidine from other sedatives in anticipation of extubation has proven to be useful and efficacious in providing sedation without causing respiratory depression. Future studies in comparing the safety and efficacy of dexmedetomidine versus other sedatives should be carried out in this hospital.


References:

1. Sanford, M. and K. Sands, Use of Dexmedetomidine for Primary Sedation in a General Intensive Care Unit, Critical Care Nurse, 2010. 30(1): p. 29 - 38. 
2. Arpino PA, Kalafatas K, Thompson BT, 
Feasibility of dexmedetomidine in facilitating extubation in the intensive care unit, Journal of Clinical Pharmacy and Therapeutics, 2008. 3(1): p. 25-30



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