Use of dexmedetomidine to facilitate extubation in surgical intensive-care-unit patients who failed previous weaning attempts following prolonged mechanical ventilation: a pilot study.
BACKGROUND
Dexmedetomidine is a selective alpha-2 adrenergic receptor agonist that exhibits sedative, analgesic, anxiolytic, and sympatholytic effects without respiratory-drive depression. We prospectively evaluated the use of dexmedetomidine to facilitate the withdrawal of mechanical ventilation and extubation in 5 trauma/surgical intensive-care-unit patients who had failed previous weaning attempts due to agitation and hyperdynamic cardiopulmonary response.


METHODS
Intravenous infusion of dexmedetomidine commenced at 0.5 or 0.7 microg/kg/h without a loading dose. Background sedation and analgesia with propofol, benzodiazepines, and opiates was discontinued or reduced as tolerated. Dexmedetomidine infusion was titrated between 0.2 and 0.7 microg/kg/h to maintain a stable cardiopulmonary response and modified Ramsay Sedation Score between 2 and 4.


RESULTS
Following dexmedetomidine administration, propofol infusion was weaned and discontinued in 4 patients. In the fifth patient, benzodiazepine and opiate infusions were reduced. Ventilatory support in all patients could be weaned to continuous positive airway pressure of 5 cm H2O without agitation, hemodynamic instability, or respiratory decompensation. All patients were extubated while receiving dexmedetomidine infusion (mean dose of 0.32 +/- 0.08 microg/kg/h). One patient required reintubation for upper-airway obstruction.


CONCLUSIONS
Dexmedetomidine appears to maintain adequate sedation without hemodynamic instability or respiratory-drive depression, and thus may facilitate extubation in agitated difficult-to-wean patients; it therefore deserves further investigation toward this novel use.
Siobal
Mark S
MS
Respiratory Care Services, Department of Anesthesia and Perioperative Care, San Francisco General Hospital, CA 94110, USA.
Kallet
Richard H
RH
Kivett
Valerie A
VA
Tang
Julin F
JF
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D003422:Critical Care; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012121:Respiration, Artificial; D014481:United States; D015300:Ventilator Weaning / Q000379:methods*
D000316:Adrenergic alpha-Agonists; D020927:Dexmedetomidine