CP-169 Dexmedetomidine for sedation in critically ill patients: a single centre experience

Abstract

Background The use of dexmedetomidine (dex) in Spanish intensive care units (ICU) patients is still unusual. Purpose To describe the use of dex as a sedative agent and asses the adherence to the 2013-SEMICYUC guideline recommendations, in a 20-bed Spanish ICU. Material and methods Retrospective six-month study (10/13–03/14) of patients treated with dex for sedation. The variables analysed were: indication for and duration of dex use, starting-maximum-maintenance doses, time to reach maintenance dose, co-administration of other sedatives, proportion of time in target sedation range (defined as a RASS score between −3 and 0) before and after dex initiation, duration of mechanical ventilation, % of patients with adverse events (AE) and causes of dex discontinuation. Results 14 patients were included. Dex indications were: to facilitate weaning (8; 57%), patient-ventilator synchrony (5; 36%), or to reduce other sedatives (1; 7%). The mean length of the treatment was 4.1 days (0.2–14.5). The mean starting/maximum/maintenance doses were 0.36 ± 0.15/0.91 ± 0.34/0.87 ± 0.33 µg/kg/h. The starting dose was 51% lower than the recommended (0.7 µg/kg/h) and it took over 53 h (3–192) to reach the maintenance dose. All patients received other sedatives prior to dex, and in 6 (43%) those sedatives could be discontinued. No patients were in the target sedation range >50% of the time prior to dex, 8 (57%) reached this status after dex. The mean duration of mechanical ventilation was 17.1 ± 13 days. All patients suffered several AE (28 AE recorded). Hypotension (8; 57%) and bradycardia (6; 43%) were the most common. The causes of dex discontinuation were extubation (8; 57%), death (2; 14%), lack of efficacy (2; 14%) and AE (2; 14%, extreme bradycardia). Conclusion All the dex indications met the SEMICYUC guidelines. It seems to be useful to reach the sedation range and facilitate successful weaning. The high rate of predictable AE and the need for dosage optimisation make dex a target drug for pharmaceutical monitoring. References and/or Acknowledgements No conflict of interest.