Simona Butler, PharmD
Clinical Pharmacist Specialist in Critical Care
Michigan Medicine
Ypsilanti, MI
Disclosure information not submitted.
Angela Clark, PharmD, BCPS
Clinical Pharmacist Specialist in Critical Care
Michigan Medicine, Michigan, United States
Disclosure information not submitted.
Roberta Wilson, PharmD
Clinical Pharmacist
Michigan Medicine, United States
Disclosure information not submitted.
Anna Dubovoy, MD
Department of Anesthesia
Michigan Medicine, United States
Disclosure information not submitted.
Amy Geltz, MS, RN
Quality Improvement
Michigan Medicine, United States
Disclosure information not submitted.
Jonathan Haft, MD
Professor of Cardiac Surgery
Michigan Medicine, United States
Disclosure information not submitted.
Title: Comparison of Dexmedetomidine and Propofol on Time to Extubation in Select Cardiac Surgery Patients
Introduction: There are many complications of prolonged intubation, including ventilator-associated pneumonia, ventilator-induced lung injury, decreased mobility leading to deep vein thrombosis, prolonged sedation leading to delirium, and increased length of stay (LOS) in both the intensive care unit (ICU) and the hospital. Published literature provides mixed results on which sedation agent, propofol or dexmedetomidine(DEX), is associated with shorter intubation periods following cardiac surgery. While some studies have demonstrated significantly shorter intubation periods with DEX, others have found no difference between the two medications. The purpose of this study was to evaluate the effects of DEX vs. propofol on time to extubation in select cardiac patients at Michigan Medicine (MM).
Methods: This study was a retrospective chart review of adult cardiac surgery patients receiving either DEX or propofol after coronary artery bypass grafting and/or valvular surgery from January 1, 2019 through December 31, 2019. Data collected included demographic information, ICU LOS, hospital LOS, number of ventilator hours, extubation <4 hours, sedation agent, and cardiac surgery type. The primary outcomes were number of ventilator hours and extubation <4 hours. The secondary outcomes were ICU LOS and hospital LOS.
Results: Of 396 patients included in the analysis, 5.3% received DEX only, 74% received propofol only, and 20.7% received both DEX and propofol. There was no difference in time to extubation between DEX and propofol (p=0.931). Time to extubation was longer with both sedatives compared to DEX alone (p=0.009) and propofol alone (p< 0.001). There was no difference in rate of extubation < 4h between DEX and propofol, however, it was lower with both sedatives compared to DEX alone and propofol alone (p< 0.001). There was no significant difference in ICU and hospital LOS between DEX alone and propofol alone patients, patients who received both sedative agents had significantly longer ICU LOS, and hospital LOS.
Conclusions: For select cardiac surgery patients at MM, choice of sedative agent between DEX and propofol did not affect extubation < 4h, time to extubation, ICU LOS, or hospital LOS. Patients who received both sedative agents had significantly longer time to extubation, ICU LOS, and hospital LOS.