TY - JOUR
T1 - Dexmedetomidine in the emergency department
T2 - A prospective observational cohort study
AU - Baumgartner, Kevin
AU - Joseph, Matt
AU - Lothet, Emilie
AU - Fuller, Brian M.
N1 - Publisher Copyright:
© 2023 Society for Academic Emergency Medicine.
PY - 2024/3
Y1 - 2024/3
N2 - Background: Dexmedetomidine (DEX) is a centrally acting sympatholytic sedative. Abundant evidence from the intensive care unit and other settings demonstrates that the use of DEX is associated with improved sedation-related outcomes. There is a paucity of data on the use and efficacy of DEX in the emergency department (ED). Methods: We performed a prospective single-center observational cohort study of patients treated with intravenous DEX for any indication in the ED. We performed serial bedside evaluations of sedation depth and delirium and administered standardized questionnaires to ED physicians about their use of DEX. We assessed the incidence of hemodynamic adverse events (HAEs; bradycardia or hypotension), clinically significant HAEs (HAEs accompanied by clinical intervention or discontinuation of DEX), sedation-related ED outcomes, and clinician perception of DEX effectiveness. Results: We enrolled 75 patients treated with DEX in the ED during our study period. The most common indication for DEX was noninvasive positive pressure ventilation (32 patients, 43%). DEX was administered in the ED for a median of 2.6 h (interquartile range [IQR] 1.6–4.9 h), with a median infusion rate of 0.3 μg/kg/h (IQR 0.2–0.4 μg/kg/h). Clinically significant HAE occurred in nine patients (12%, 95% CI 6%–22%). Other sedative or analgesic infusions were administered in the ED to 21 patients (28%). Clinicians felt DEX was highly effective (median [IQR] effectiveness score of 5 [3–5] on a 5-point Likert scale). The median (IQR) ED Richmond Agitation Sedation Scale post-DEX was −1 (−4 to 0). Conclusions: DEX is used in the ED for diverse indications. Additional data from larger cohorts and comparative studies are required to determine the precise incidence of clinically significant HAE associated with DEX use in the ED. ED clinicians have a positive perception of the effectiveness of DEX.
AB - Background: Dexmedetomidine (DEX) is a centrally acting sympatholytic sedative. Abundant evidence from the intensive care unit and other settings demonstrates that the use of DEX is associated with improved sedation-related outcomes. There is a paucity of data on the use and efficacy of DEX in the emergency department (ED). Methods: We performed a prospective single-center observational cohort study of patients treated with intravenous DEX for any indication in the ED. We performed serial bedside evaluations of sedation depth and delirium and administered standardized questionnaires to ED physicians about their use of DEX. We assessed the incidence of hemodynamic adverse events (HAEs; bradycardia or hypotension), clinically significant HAEs (HAEs accompanied by clinical intervention or discontinuation of DEX), sedation-related ED outcomes, and clinician perception of DEX effectiveness. Results: We enrolled 75 patients treated with DEX in the ED during our study period. The most common indication for DEX was noninvasive positive pressure ventilation (32 patients, 43%). DEX was administered in the ED for a median of 2.6 h (interquartile range [IQR] 1.6–4.9 h), with a median infusion rate of 0.3 μg/kg/h (IQR 0.2–0.4 μg/kg/h). Clinically significant HAE occurred in nine patients (12%, 95% CI 6%–22%). Other sedative or analgesic infusions were administered in the ED to 21 patients (28%). Clinicians felt DEX was highly effective (median [IQR] effectiveness score of 5 [3–5] on a 5-point Likert scale). The median (IQR) ED Richmond Agitation Sedation Scale post-DEX was −1 (−4 to 0). Conclusions: DEX is used in the ED for diverse indications. Additional data from larger cohorts and comparative studies are required to determine the precise incidence of clinically significant HAE associated with DEX use in the ED. ED clinicians have a positive perception of the effectiveness of DEX.
UR - http://www.scopus.com/inward/record.url?scp=85184914150&partnerID=8YFLogxK
U2 - 10.1111/acem.14842
DO - 10.1111/acem.14842
M3 - Article
C2 - 38060343
AN - SCOPUS:85184914150
SN - 1069-6563
VL - 31
SP - 263
EP - 272
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 3
ER -