.jpg "Megan Ingebrigtson, BCCCP, PharmD, photo")
Megan Ingebrigtson, BCCCP, PharmD,
Critical Care Pharmacist
University Health System
San Antonio, Texas
Disclosure information not submitted.
James Miller, BCCCP, PharmD
Pharmacist
Michigan Medicine, United States
Disclosure information not submitted.
Title: Adverse hemodynamic effects of dexmedetomidine in critically ill elderly adults
Background: Dexmedetomidine is currently recommended as a first-line sedative agent for critically ill patients requiring mechanical ventilation. Recent trials have demonstrated no difference in clinical outcomes between patients treated with dexmedetomidine versus usual care, though there were significantly more hemodynamic adverse effects in the dexmedetomidine group. Interestingly, one subgroup analysis suggested a 90-day mortality benefit in elderly patients, but no distinction was made between the two groups regarding age when reporting adverse effects. Given potential decreased baroreceptor function in the elderly, the adverse hemodynamic effects of dexmedetomidine may impact a higher proportion of patients in this age group. The objective of this study is to assess the incidence of adverse hemodynamic effects of dexmedetomidine in elderly ICU patients compared to other sedative agents in order to clarify the role of dexmedetomidine in this patient population.
Methods: This was a single-center, retrospective study including mechanically ventilated elderly patients requiring sedative agents for at ≥ 12 hours. The primary outcome evaluated was a composite end point of incidence of bradycardia and hypotension. Secondary outcomes included incidence of each adverse event component of the primary endpoint, hospital and intensive care unit length of stay, and duration of mechanical ventilation.
Results: No difference was found between the groups in the primary outcome with 58.7% (37 of 63) experiencing an adverse event in the dexmedetomidine group and 74.1% (43 of 58) in the usual care group (p=0.074). No difference was seen in hospital or intensive care unit length of stay. Patients in the dexmedetomidine group were on the ventilator longer than the patients in the usual care group with a median of 6 versus 3 days, respectively (p=0.004).
Conclusion: In this single-center, retrospective study dexmedetomidine had a similar incidence of adverse events in elderly patients compared to the usual care group.