1015: COMPARISON OF DEXMEDETOMIDINE HIGH AND LOW MAXIMUM DOSE STRATEGIES IN A LARGE HEALTH SYSTEM

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Introduction: Different maximum doses of dexmedetomidine are utilized in various studies, with some evidence that higher doses (>0.7 mcg/kg/hr) are not more effective. Our large health system utilizes two different dexmedetomidine order sets in different regions; with different high (up to 1.5 mcg/kg/hr) and low (0.7 mcg/kg/hr) maximum doses and duration limits in place (48hr and 24hr) to encourage use for short term sedation. We hypothesize that there will be no improvement in time to/spent in RASS goal with the high dose (HD) vs. low dose (LD) regimen. Methods: This retrospective evaluation compared adult ICU patients who utilized the HD or LD dexmedetomidine order sets in April-May 2021. Patients on ECMO, in the OR, or with pre-existing bradycardia (HR < 50 bpm) were excluded. Objective was to determine impact on time in/to RASS goal, and secondary outcomes of concomitant sedative use, ICU length of stay, adverse events (hypotension, bradycardia), and therapy duration. Results: 198 patients were reviewed (100 LD, 98 HD). Patients achieved goal sedation (targeted RASS goal) earlier in the LD vs. HD group with time to goal of 1.63 hr and 5.85 hr. Percent of time in goal was also greater (74.5% vs. 66.1%). For secondary outcomes, LD had a similar number of patients using concomitant continuous sedation compared to HD (37% vs. 30%) and utilized more PRN sedative doses (64% vs. 35%). The LD and HD groups experienced similar amounts of hypotension (53% and 46%), but there was more bradycardia with LD (40% vs. 21%), possibly due to overall higher illness acuity indicated by a median ICU length of stay of 12 days (LD) and 6.5 days (HD). Despite different automatic order expiration dates (48 hr vs. 24 hr), duration of therapy for all patients who received dexmedetomidine was similar [median 17.8 hr (LD) and 20.5 hr (HD)]. Within the HD group, < 10% of patients required median doses > 1.2 mcg/kg/hr. Conclusions: A higher maximum dexmedetomidine dose order set did not lead to superior outcomes of time to RASS goal or percentage of time at goal. The order renewal requirement difference of 24 vs 48 hours did not significantly impact overall median duration. The health system will adopt the LD strategy with a default maximum dose of 0.7 mcg/kg/hr and 48-hour order duration limit across all hospitals.