Dexmedetomidine Use in Critically Ill Adults at a Large Canadian Academic Teaching Hospital
CCCF ePoster library. Kanji S. Nov 1, 2016; 150957; 76 Disclosure(s): None
Dr. Salmaan Kanji
Dr. Salmaan Kanji
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Abstract
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Topic: Retrospective or Prospective Cohort Study

Dexmedetomidine Use in Critically Ill Adults at a Large Canadian Academic Teaching Hospital


Kanji S1,2; Cho A1; Edgar D1; Fairbairn J1; Johanson C1; Maclean B1; Patel R2; PIttman M1; Rosenberg E2 SIngh A1

1Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada
2Ottawa Hospital Research Institute
3Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada



Abstract:

Introduction: Sedation for critically ill patients is intended to reduce discomfort, anxiety and agitation while facilitating mechanical ventilation. Dexmedetomidine offers some pharmacodynamics advantages over other available sedatives and has been available in Canada since 2011.  Despite a growing body of evidence for its clinical utility its role relative to other agents has not been well defined in the context of critical care in Canada.

Objectives: To describe the utilization, effectiveness and safety of dexmedetomidine administered to mechanically ventilated patients in two intensive care units (ICU) at the Ottawa Hospital.


Method: This was a retrospective observational cohort study of consecutive ICU patients identified from pharmacy records who received dexmedetomidine between May 2014 to December 2015. Data describing patient demographics, indications for use, prescribing characteristics, efficacy and safety outcomes were collected using a standardized and pre-piloted case report form.   

Results: One hundred and one prescriptions were identified from 89 patients admitted to one of the two participating ICUs.  Among the 101 dexmedetomidine orders reviewed, 66 orders(65.3%) were prescribed to facilitation extubation in agitated patients while 35 orders (34.7%) were for general sedation. For those in whom dexmedetomidine was prescribed to facilitate extubation the median time to extubation 7.9h (0.2 – 62.7h) and the rate of successful extubation was 81.8% when attempted. The most common reason for extubation failure was excessive oropharyngeal secretions. For those receiving dexmedetomidine for general sedation the use of other sedatives (midazolam and propofol) and opioids (hydromorphone and fentanyl) were significantly reduced.  Hypotension and bradycardia were observed in 31 (30.7%)  and 12 (11.9%) cases, respectively.

Conclusion: The pharmacodynamics properties of dexmedetomidine coupled with its higher acquisition cost than other commonly used alternatives limits its utility to highly selected populations of ICU patients.  At this institution the most common indications for short term use are to facilitate extubation or to provide lighter levels of sedation in agitated or delirious patients.  While the outcomes of these patients are similar to expected rates in non-agitated or delirious patients, hypotension and bradycardia are common.


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