Use of Dexemedetomidine beyond 24 hours in the intensive care unit

Introduction

Adequate sedation of critically ill patients is essential to ensure maximal quality of care in the high-stress enviroment of the intensive care unit. The main goals of sedation include augmentation of pain control, management of agitation and psychological distress, and improvement of patient tolerance and acceptance of the endotracheal tube and ventilatory support.

Dexemedetomidine (DEX) is a potent α₂-adrenoceptor agonist with an α₂: α₁ ratio of 1300:1 that produces stable tranquility with rousability. DEX permits haemodynamic stability by effectively blunting both cathecolamine and haemodynamic responses to endotracheal intubations, surgical stress, and arousal from anesthesia.

Materials and methods

A retrospective analysis of the data of 240 patients admitted to a 27-bed general intensive care unit (ICU) from October 2000 to May 2002 was performed.

We evaluated duration of DEX usage, posology – average and maximum doses, length of stay in ICU, and patient average age.

Results

Patient age average was 65.3 years and APACHE II score was 13.4. The average dose used was 0.3 μg/kg per hour (0.2–0.6). Time of usage was 3.24 days (1–19 days). The length of hospitalization was 8.9 days.

Conclusions

The use of Dexmedetomidine beyond 24 hours appears to be safe and effective for the sedation of ICU patients. The need for other sedating/analgesic drugs occurred in less than one-quarter of the patients and was well tolerated with no extra pyramidal signs seen with antipsychotic drugs or respiratory depression with opiates.