Introduction: Studies have demonstrated safety and efficacy of dexmedetomidine infusions at doses up to 1.5 mcg/kg/hr. Data evaluating doses greater than 1.5 mcg/kg/hr is limited; however, up to 2.5 mcg/kg/hr has been utilized. It is uncertain whether higher doses provide additional benefit but may result in more adverse events. The purpose of this study was to compare the safety and efficacy of dexmedetomidine at high doses (greater than 1.5 mcg/kg/hr) versus standard doses (0.2 to 1.5 mcg/kg/hr).
Methods:A retrospective cohort study was conducted in critically ill, mechanically ventilated patients receiving dexmedetomidine for at least 24 hours. Standard dose dexmedetomidine (SD-DEX) was defined as less than or equal to 1.5 mcg/kg/ hr and high dose (HD-DEX) as greater than 1.5 mcg/kg/hr. Patients were assigned to SD-DEX group if maximum dose of dexmedetomidine received was between 0.2 and 1.5 mcg/kg/hr. Conversely, patients were assigned to HD-DEX group if maximum dose of dexmedetomidine received was greater than 1.5 mcg/kg/hr. Composite incidence of bradycardia or hypotension and proportion of time within target sedation were assessed.Results: A total of 799 patients were screened for inclusion with 120 included: 69 in the HD-DEX group and 51 in the SD-DEX group. Composite incidence of bradycardia or hypotension was not statistically different. A significantly larger proportion of time was spent within target sedation in the SD-DEX group. More patients in the HD-DEX group required sedatives and antipsychotics than the SD-DEX group and tended to receive higher daily doses of concomitant medications.
Conclusion:Dexmedetomidine doses greater than 1.5 mcg/kg/hr may be as safe as standard doses; however, no additional benefit in maintaining target sedation level was found.
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The timely administration of analgesics is crucial to the comprehensive management of trauma patients. When an emergency department (ED) pharmacist participates in trauma resuscitation, the pharmacist acts as a medication resource for trauma team members and facilitates the timely administration of analgesics. This study measured the impact of a pharmacist on time to first analgesic dose administered during trauma resuscitation. All adult (>18 years) patients who presented to this level II trauma center via activation of the trauma response system between January 1, 2009, and May 31, 2013, were screened for eligibility. For inclusion, patients must have received intravenous fentanyl, morphine, or hydromorphone in the trauma bay. The time to medication administration was defined as the elapsed time from ED arrival to administration of first analgesic. There were 1328 trauma response system activations during the study period; of which 340 patients were included. The most common analgesic administered was fentanyl (62% in both groups). When a pharmacist was participating, the mean time to first analgesic administered was decreased (17 vs 21 minutes; P = .03). Among the 78% of patients with documented pain scores, the overall mean reduction in pain scores from ED arrival to ED discharge was similar between the 2 groups. There was a 2.4 point reduction with a pharmacist versus 2.7 without a pharmacist, using a 0 to 10 numeric pain rating scale. The participation of a clinical pharmacist during trauma resuscitation significantly decreased the time to first analgesic administration in trauma patients. The results of this study supplement the literature supporting the integration of clinical ED pharmacists on trauma teams.
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