PSY140 - DEXMEDETOMIDINE UTILISATION STUDY IN THE INTENSIVE CARE UNIT

Abstract

To describe the patterns of dexmedetomidine use in the Intensive Care Unit (ICU) in a tertiary hospital and the impact of pharmacy intervention on it. Prospective four-month study (October 2017-January 2018). There was a greater use of dexmedetomidine in November so pharmacists encouraged physicians to consider protocols before prescribing. Dexmedetomidine 1mg/10 ml vial is administered as a solution (4 mcg/ml) by intravenous perfusion at dose range: 0.2-1.4 mcg/kg/hour. Data collected: treatment days with dexmedetomidine or sedative drugs combination, oral clonidine consumption, dexmedetomidine solution used (ml/day), infusion rates used (milliliters/h), RASS level and vials dispensed/month. Thirty-one patients received dexmedetomidine. Median duration of treatment was 1.8 days(maximum 8 days). Two patients(6.5%) received the combination formed by Remifentanil+Propofol+Midazolam+Dexmedetomidine, although it was less than 24 hours. Average dexmedetomidine solution administered/patient: 175 ml/day(48-672); average dexmedetomidine infusion rate: 9.9 ml/h(2-28). RASS level was not recorded any time during dexmedetomidine treatment in 13 patients (41.9%). Seven patients(22.6%) registered a RASS value lower than -3, two of them received treatment with dexmedetomidine during 6 and 7 days of respectively. Dexmedetomidine consumption in ICU was 26, 114, 91 and 76 vials for each month of this study. In three patients(9.7%) dexmedetomidine was replaced by clonidine when possible (clonidine was not prescribed in the first two months; in December and in January it was dispensed 91 and 48 tablets respectively). During the study, two cases of incorrect use were detected(6.5%). Dexmedetomidine consumption has been clearly reduced since the intervention halfway through the study period, and the use of clonidine was favored in its place. In most cases the use of dexmedetomidine was indicated and correctly justified. The importance in these cases lies in the need to establish maximum times from which the combination of dexmedetomidine should not be overcome with several sedatives for own use in deep sedation levels.