title: Dexmedetomidine in the care of critically ill patients from 2001 to 2007: an observational cohort study.
abstract: BACKGROUND
  Dexmedetomidine is a novel sedative agent that causes anxiolysis without respiratory depression in critically ill patients. We sought to examine patient and hospital variation in dexmedetomidine use and adoption patterns of dexmedetomidine over time.
  
  
  METHODS
  We performed a retrospective cohort study of all patients who received intravenous infusion sedation in 174 intensive care units contributing data to Project IMPACT from 2001 through 2007. Sedation use was defined as having received an intravenous sedative infusion (dexmedetomidine, midazolam, lorazepam, or propofol) for any period during the intensive care stay. The primary outcome was use of dexmedetomidine in the intensive care unit.
  
  
  RESULTS
  Of 58,391 patients who received intravenous infusion sedation, 2,535 (4.3%, 95% confidence interval [CI], 4.2-4.5) received dexmedetomidine. Overall use was highest in cardiac surgery patients (11.7%, 10.8-12.7) and was similar in other surgical patients (4.3%, 4.0-4.6) and medical patients (3.4%, 3.2-3.6, P < 0.001). Use of dexmedetomidine increased from 2.0% (1.6-2.4) of patients receiving intravenous infusion sedation in 2001 to 7.2% (6.6-7.9) in 2007 (P < 0.001), primarily because of an increase in use in cardiac surgery patients (1.4%, 0.0-2.8, in 2001 vs. 20.2%, 17.6-22.8 in 2007, P < 0.001). Of the patients who received dexmedetomidine, 31.5% (29.6-33.3) received the infusion for more than 1 day, and 10.9% were not mechanically ventilated.
  
  
  CONCLUSIONS
  Use of dexmedetomidine in critically ill patients has increased over time, primarily as a result of an increase in use among cardiac surgery patients. A substantial portion of dexmedetomidine was administered outside of the regulatory approval guidelines at the time.
authors.affiliation: Department of Anesthesiology, Columbia University, New York, New York, USA. hw2125@columbia.edu
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Kramer
authors.forename: Gebhard
authors.initials: G
authors.lastname: Wagener
authors.forename: Guohua
authors.initials: G
authors.lastname: Li
authors.forename: Robert N
authors.initials: RN
authors.lastname: Sladen
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
mesh_terms: D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy*; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units / Q000639:trends*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D014151:Anti-Anxiety Agents; D020927:Dexmedetomidine