In this episode, I’ll discuss predicting the success of dexmedetomidine as a sedative.
Anecdotally, dexmedetomidine has always seemed like a hit-or-miss sedative, working wonderfully in many patients and barely or not at all in others.
Researchers recently published in Pharmacotherapy a single-center, retrospective, cohort study of 158 critically ill adult patients receiving dexmedetomidine to identify factors associated with clinical success.
Success was defined as having a mean time within goal RASS score of 60% or greater in the first 48 hours of mechanical ventilation after intubation. The goal RASS score was defined as 0 to -2. Patients on benzodiazepine or propofol infusions for greater than 12 hours were excluded.
Almost two-thirds of the patients achieved clinical success. Success was associated with a significantly increased mechanical ventilator-free duration at 14 days.
The authors performed a multivariate analysis looking at 9 factors in regards to the chance of clinical success:
- RASS prior to dexmedetomidine
- Initiation of dexmedetomidine with fentanyl
- SOFA score at dexmedetomidine initiation
- Medical or cardiac ICU
- Alcohol, opioid, or other substance abuse disorder
- Liver disease
- Anxiety or depression
- Sleep disorder
Of the 9 possible factors, only SOFA score at initiation predicted response to dexmedetomidine. The odds of success were decreased by 9% for every point increase in sequential organ failure assessment score. While this finding was statistically significant, the 95% confidence interval was 0.82‐0.99.
While the study is limited by its retrospective single-center design, it may be helpful identifying a population of patients with the highest likelihood of clinical success using dexmedetomidine for light sedation.
Members of my Hospital Pharmacy Academy have access to practical training from a pharmacist’s point of view on using dexmedetomidine in critical care. This is in addition to many other resources to help in your practice. The Hospital Pharmacy Academy is my online membership site that teaches pharmacists practical critical care and hospital pharmacy skills you can apply at the bedside so that you can become confident in your ability to save lives and improve patient outcomes. To get immediate access, go to pharmacyjoe.com/academy.
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