Christine Kim, PharmD
Brigham & Women's Hospital
Boston, Massachusetts
Disclosure information not submitted.
Kaitlin Crowley, BCCCP, BCPS, PharmD (she/her/hers)
Clinical Pharmacy Specialist
Brigham & Women's Hospital
Disclosure information not submitted.
Kevin McLaughlin, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist
Brigham and Women's Hospital, United States
Disclosure information not submitted.
Natasha Romero, PharmD, BCCCP, BCPS
Pharmacist
Memorial Healthcare System, United States
Disclosure information not submitted.
Title: Evaluation of dexmedetomidine withdrawal and management after prolonged infusion
INTRODUCTION/HYPOTHESIS: Dexmedetomidine (DEX) is often used for longer than its labeled indication of 24 hours, raising concerns for potential withdrawal. Data are limited regarding this syndrome in adult ICU patients. The goal of this analysis was to further identify DEX withdrawal in adult ICU patients after prolonged use.
Methods: This was an IRB-approved, single-center, retrospective chart review conducted at a tertiary academic medical center. Adult ICU patients who received DEX for ≥72 hours in 2019 were screened for inclusion. Exclusion criteria were interruption in infusion for >6 hours, indications other than sedation, or patients presenting with neurological or burn injury. The major endpoint was the incidence of DEX withdrawal, defined as meeting ≥2 of the following within 24 hours of discontinuation: newly positive Confusion Assessment Method for ICU, Richmond Agitation Sedation Scale ≥+2, hypertension, or tachycardia. Minor endpoints were incidence of individual withdrawal signs, additional sedatives or antipsychotics required, dose and duration of DEX, length of ventilation, ICU and hospital stay, and new onset of the following: fever, vomiting, loose stools/diarrhea, diaphoresis, or seizure.
Results: Of the 152 patients included, DEX withdrawal occurred in 54 patients (35.5%). Rebound hypertension was the most common withdrawal sign [47 patients (87.0%)]. When comparing the groups with and without withdrawal, there was a significant difference in the incidence of loose stools/diarrhea [4 (7.4%) vs. 1 (1.0%), p = 0.03], but not in the other symptoms evaluated. In the withdrawal group, significantly more patients required additional beta-blockers [29 (53.7%) vs. 10 (10.2%), p < 0.01], were reinitiated on DEX [16 (29.6%) vs. 10 (10.2%), p < 0.01] and required a start or increased dose of clonidine [6 (11.1%) vs. 3 (3.1%), p = 0.04]. There was no difference in the cumulative dose or duration of DEX between the groups. Length of ventilation was longer in the withdrawal group [171 h (83.7-280.8 h) vs. 159 h (149.0-335.7 h), p < 0.01], but there was no difference in ICU or hospital length of stay.
Conclusions: Prolonged use of DEX was associated with withdrawal syndrome in 35.5% of patients. Larger trials are needed to confirm the risk factors for DEX withdrawal and identify measures to prevent withdrawal.