Prescribing patterns of dexmedetomidine in the intensive care unit and impact on supplemental pain and sedation medications

Introduction:

Dexmedetomidine use in our community-based intensive care unit (ICU) has increased since the implementation of recent Pain, Agitation and Delirium guidelines however some indications may be outside the recommendations 

Objectives:

The primary objective of this medication use evaluation was to describe the patient population and the indication for dexmedetomidine orders. Secondary objectives include duration of use and impact on other sedative or pain medications. 

Study Design:  A retrospective chart review with prescribing indications documented concurrently.

Methods:

Adult patients admitted to the ICU between November 2014 and April 2015 with an order for dexmedetomidine were evaluated for inclusion. Patients who never received the ordered dexmedetomidine or received it outside of the ICU were excluded. Electronic medical records were retrospectively reviewed to collect patient demographics, duration of administration of dexmedetomidine and quantity of other sedative or pain medications administered. Indication was assessed from patient notes or in discussion with providers during the time of prescribing. 

Results:

Twenty-six orders of dexmedetomidine were reviewed across 23 patients. The indications for dexmedetomidine use were failure of previous sedation therapy (34%), ventilator weaning (27%), primary agent for sedation (23%), lighter sedation for neurological evaluation (8%), alcohol withdrawal (4%), and miscellaneous (4%). Average infusion time for all patients was 23.8±22.9 hours. Patients received an average of 4 doses of opioids per day and 2 doses of benzodiazepines per day during dexmedetomidine use. The average time of infusion in the failure of previous therapy and ventilator weaning subgroups were 36.81±27.2 hours and 16.46± 8.2 hours respectively. Both subgroups received more bolus doses of opioids and benzodiazepines while on dexmedetomidine versus off.

Conclusions:

Dexmedetomidine was used most commonly for the indications failure of previous therapy and ventilator weaning. The use of dexmedetomidine was consistent with the guideline suggested indications however it did not decrease the use of supplemental analgesia or sedation.