The use of dexmedetomidine in the emergency department: A systematic review

Abstract

Sedatives, anxiolytics, and analgesics are near-ubiquitous interventions during daily care in the emergency department (ED). The agents most commonly used to treat intubated patients include sedatives acting on the gamma-aminobutyric acid (GABA) receptor, such as benzodiazepines and propofol, as well as the opioid analgesic fentanyl. Benzodiazepines are highly deliriogenic 1 and may prolong duration of mechanical ventilation and length of stay. 2 Propofol can be associated with significant hypotension and with a life-threatening

Dexmedetomidine in the emergency department: A prospective observational cohort study

“…Larger observational studies will be required to more precisely define and characterize the risk of these events. Our results are generally consistent with previous safety data in the ED setting, 11 although definitions of HAEs in previous work have been inconsistent and many previous ED‐based studies have not specifically reported safety data. Direct comparison with large ICU‐based clinical trials is problematic due to varying definitions of HAE and the difference in populations studied.…”

“…A sample size calculation was not performed a priori because the primary analysis was descriptive and focused on characterization of DEX use in the ED and clinician perceptions of DEX. Based on previous data, 11,12 our sample size was recognized as likely to be adequate for investigation of ED DEX use.…”

“…9,10 The emergency department (ED) is a care domain in which DEX could be effectively used to improve outcome, yet the use of DEX in the ED is uncommon and understudied. 11 Barriers to the use of DEX in the ED have not been systematically studied but may include unfamiliarity, lack of high-quality data to support use, hospital policies limiting DEX use, and the slow onset of action of DEX. 1 A comprehensive systematic review on DEX in the ED found that the evidence on ED DEX use was sparse and generally of low quality.…”

“…1 A comprehensive systematic review on DEX in the ED found that the evidence on ED DEX use was sparse and generally of low quality. 11 In a previous single-center retrospective cohort study conducted by our research team in our ED, of 103 patients treated with DEX in the ED, DEX was used for multiple indications, including the facilitation of positive pressure ventilation (MV and NIPPV). 12 The incidence of bradycardia and hypotension was 18% and 40%, respectively; however, discontinuation of DEX was uncommon, suggesting that these hemodynamic adverse effects were well tolerated clinically.…”

“…Barriers to the use of DEX in the ED have not been systematically studied but may include unfamiliarity, lack of high‐quality data to support use, hospital policies limiting DEX use, and the slow onset of action of DEX 1 . A comprehensive systematic review on DEX in the ED found that the evidence on ED DEX use was sparse and generally of low quality 11 . In a previous single‐center retrospective cohort study conducted by our research team in our ED, of 103 patients treated with DEX in the ED, DEX was used for multiple indications, including the facilitation of positive pressure ventilation (MV and NIPPV) 12 .…”