Jack Lukas, PharmD,
PGY2 Pharmacy Resident- Critical Care
Methodist University Hospital
Memphis, Tennessee
Disclosure information not submitted.
Michael Samarin, BCCCP, BCPS, PharmD
Pharmacist
Methodist University Hospital, United States
Disclosure information not submitted.
Asia Rujevcan, PharmD
Pharmacist
Methodist University Hospital, United States
Disclosure information not submitted.
G. Morgan Jones, BCPS, PharmD
Clinical Pharmacy Specialist - Neurocritical Care
Methodist LeBonheur Healthcare
Germantown, Tennessee, United States
Disclosure information not submitted.
Title: Evaluation of Concomitant Atypical Antipsychotic Administration on Dexmedetomidine Dose Requirements
Introduction/Hypothesis: Dexmedetomidine (DEX) is commonly used the intensive care unit (ICU). However, patients may experience rebound agitation when weaning the continuous infusion, which may result in prolonged treatment in some patients. Evidence suggests atypical antipsychotics can be used to control agitation in the ICU. Because these agents exert pharmacological actions on central alpha-2 receptors, it has been hypothesized that they may facilitate weaning of DEX infusions. This study aims to describe the impact of initiating atypical antipsychotics on DEX dosing requirements in ICU patients.
Methodology: We conducted a retrospective analysis of adult ICU patients receiving DEX concurrently with at least two doses of atypical antipsychotics. Included patients were further stratified into either a medical cohort (sepsis or respiratory failure) or neurologic cohort (hemorrhagic or ischemic stroke) for analysis. The primary outcome was the duration and maximum dose of DEX after initiating atypical antipsychotics. Secondary objectives were to determine if there was a difference in these outcomes when comparing patients based upon admission diagnosis groups.
Results: Of 800 eligible patients screened, 191 were included. Patients had a median [25%-75% interquartile range] age of 60.0 [49.5-68] years. The majority were male (64.4%), African American (50.8%), and had a primary admission diagnosis that was medical in nature (80.6%). The most commonly used atypical antipsychotic was quetiapine (89.5%). Prior to initiation of atypical antipsychotics, median duration of DEX use was 2.1 [1.0-4.7] days at a median maximum dose of 1.0 [0.6-1.4] mcg/kg/hr. Median duration of infusion after atypical antipsychotic initiation was 2.6 [1.4-4.9] days at a median maximum dose of 1.0 [0.6-1.4] mcg/kg/hr. Analysis based on admission diagnosis showed both duration and maximum dose of DEX after initiation of atypical antipsychotics were statistically significantly higher in the medical compared to the neurological cohort.
Conclusion: We observed similar duration and maximum dose of DEX infusion before and after initiation of atypical antipsychotics. When analyzed by admission diagnosis, the neurologic cohort was treated for a shorter duration and at lower doses than the medical cohort after atypical antipsychotic initiation.