Next Article in Journal
Pharmacists’ Activities to Reduce Medication Waste: An International Survey
Previous Article in Journal
Evaluation of Home Medication Reconciliation by Clinical Pharmacists for Adult and Pediatric Cystic Fibrosis Patients
Article Menu
Issue 3 (September) cover image

Export Article

Open AccessArticle
Pharmacy 2018, 6(3), 93; https://doi.org/10.3390/pharmacy6030093

Outcomes When Using Adjunct Dexmedetomidine with Propofol Sedation in Mechanically Ventilated Surgical Intensive Care Patients

1
Department of Pharmacy, University of Utah Health, Salt Lake City, UT 84132, USA
2
Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, CA 90004, USA
3
Department of Surgery, University of Utah Health, Salt Lake City, UT 84132, USA
4
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
5
Department of Pharmacy Practice, University of Utah College of Pharmacy, Salt Lake City, UT 84132, USA
*
Author to whom correspondence should be addressed.
Received: 6 August 2018 / Revised: 21 August 2018 / Accepted: 22 August 2018 / Published: 28 August 2018
Full-Text   |   PDF [1224 KB, uploaded 28 August 2018]   |  

Abstract

Objective: Compare the duration of mechanical ventilation between patients receiving sedation with continuous infusions of propofol alone or combination with the use of dexmedetomidine and propofol. Design: Retrospective, propensity matched (1:1) cohort study, employing eight variables chosen a priori for matching. Timing of exposure to dexmedetomidine initiation was incorporated into a matching algorithm. Setting: Level 1, university-based, 32-bed, adult, mixed trauma and surgical intensive care unit (SICU). Continuous sedation was delivered according to a protocol methodology with daily sedation vacation and spontaneous breathing trials. Choice of sedation agent was physician directed. Patients: Between 2010 and 2014, 149 SICU patients receiving mechanical ventilation for >24 h received dexmedetomidine with propofol. Propensity matching resulted in 143 pair cohorts. Interventions: Dexmedetomidine with propofol or propofol alone. Measurements and Main Results: There was no statistical difference in SICU length of stay (LOS), with a median absolute difference of 5.3 h for propofol alone group (p = 0.43). The SICU mortality was not statistically different (RR = 1.002, p = 0.88). Examining a 14-day period post-treatment with dexmedetomidine, on any given day (excluding days 1 and 14), dexmedetomidine with propofol-treated patients had a 0.5% to 22.5% greater likelihood of being delirious (CAM-ICU positive). In addition, dexmedetomidine with propofol-treated patients had a 4.5% to 18.8% higher likelihood of being above the target sedation score (more agitated) compared to propofol-alone patients. Conclusions: In this propensity matched cohort study, adjunct use of dexmedetomidine to propofol did not show a statistically significant reduction with respect to mechanical ventilation (MV) duration, SICU LOS, or SICU mortality, despite a trend toward receiving fewer hours of propofol. There was no evidence that dexmedetomidine with propofol improved sedation scores or reduced delirium. View Full-Text
Keywords: sedation agents; delirium; adjunctive use; comparative effective research; intensive care length of stay sedation agents; delirium; adjunctive use; comparative effective research; intensive care length of stay
Figures

Figure 1

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

Supplementary material

SciFeed

Share & Cite This Article

MDPI and ACS Style

Louie, J.M.; Lonardo, N.W.; Mone, M.C.; Stevens, V.W.; Deka, R.; Shipley, W.; Barton, R.G. Outcomes When Using Adjunct Dexmedetomidine with Propofol Sedation in Mechanically Ventilated Surgical Intensive Care Patients. Pharmacy 2018, 6, 93.

Show more citation formats Show less citations formats

Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Related Articles

Article Metrics

Article Access Statistics

1

Comments

[Return to top]
Pharmacy EISSN 2226-4787 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top