ICU sedation with dexmedetomidine after severe traumatic brain injury

Abstract

Objective: To comprehensively describe the use of dexmedetomidine in a single institutional series of adult ICU patients with severe TBI. This study describes the dexmedetomidine dosage and infusion times, as well as the physiological parameters, neurological status and daily narcotic requirements before, during and after dexmedetomidine infusion.

Methods: This study identified 85 adult patients with severe TBI who received dexmedetomidine infusions in the Trauma ICU at Vanderbilt University Medical Center between 2006–2010. Demographic, haemodynamic, narcotic use and sedative use data were systematically obtained from the medical record and analysed for changes associated with dexmedetomidine infusion.

Results: During infusion with dexmedetomidine, narcotic and sedative use decreased significantly (p < 0.001 and p < 0.05). Median MAP, SBP, DBP and HR also decreased significantly during infusion when compared to pre-infusion values (p < 0.001). Despite the use of dexmedetomidine, RASS and GCS scores improved from pre-infusion to infusion time periods.

Conclusions: The findings demonstrate that initiation of dexmedetomidine infusion is not associated with a decline in neurological functioning in adults with severe TBI. Although there was an observed decrease in haemodynamic parameters during infusion with dexmedetomidine, the change was not clinically significant and the requirements for narcotics and additional sedatives were minimized.

Keywords:

• Traumatic brain injury
• dexmedetomidine
• sedation

Acknowledgements

We thank M. S. Delozier for her help in the initial data extraction and verification. This study was a Local Poster Presentation at the 31st Vanderbilt Annual Research Forum on 18 April 2013; a Poster Presentation at Neurotrauma 2013, the 31st Annual Symposium of the National Neurotrauma Society on 4–7 August 2013, Nashville, TN. Sun DZ, Wilson LD, McKenna JW, Hamblin SE, Humble SS, Pandharipande PP, Patel MB. Five-Year Dexmedetomidine (Precedex) Use for Sedation after Traumatic Brain Injury. Journal of Neurotrauma 2013; 30: A41–A42. 


Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper. Financial support was provided by: REDCap, UL1 TR000445 from NCATS/NIH (all authors); NIH grants R01AG027472 (PPP), R01HL111111(MBP/PPP), R01AG035117 (PPP); AHRQ Health Services 5T32HS013833-08, AHRQ (MBP); Vanderbilt Faculty Research Scholars Program (MBP); and the Eastern Association for the Surgery of Trauma Foundation Research Scholarship (MBP).