title: Evaluation of dexmedetomidine: safety and clinical outcomes in critically ill trauma patients.
abstract: BACKGROUND
  To compare safety and clinical outcomes of prolonged infusions with standard-dose (≤0.7 μg/kg/h) dexmedetomidine (SDD) or high-dose (>0.7 μg/kg/h) dexmedetomidine (HDD) to propofol in critically ill trauma patients.
  
  
  METHODS
  This was a retrospective review of 127 adult mechanically ventilated trauma patients between 2008 and 2009, who received propofol, SDD, or HDD for >24 hours. Primary outcomes were significant changes in blood pressure or heart rate. Secondary outcomes included hospital and intensive care unit (ICU) length of stay (LOS), ventilator time, and any concomitant analgesic, sedative, and antipsychotic use. Pairwise comparisons were based on Wilcoxon rank-sum test for continuous data and Pearson's chi-square test for categorical data. Statistical significance was defined as p value <0.05.
  
  
  RESULTS
  Patients in HDD group had higher rate of hypotension (98% vs. 78%; p = 0.02) but no significant differences in heart rate compared with propofol group. These patients had median longer hospital LOS (25 days vs. 12 days; p < 0.001), ICU LOS (20 days vs. 12 days; p = 0.004), and longer ventilator time (14 days vs. 7 days; p = 0.008). They also had increased requirements for oxycodone (74% vs. 40%; p = 0.003), midazolam (36% vs. 8%; p = 0.004), and haloperidol (50% vs. 24%; p = 0.02). Patients in SDD group had longer hospital LOS compared with propofol group (21 days vs. 13 days; p < 0.001).
  
  
  CONCLUSIONS
  Higher doses of dexmedetomidine may result in higher incidence of hypotension, longer LOS, and increased concomitant analgesic, sedative, and antipsychotic use, requiring further evaluation in trauma patients.
authors.affiliation: Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Devabhakthuni
authors.forename: Mehrnaz
authors.initials: M
authors.lastname: Pajoumand
authors.forename: Carla
authors.initials: C
authors.lastname: Williams
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Kufera
authors.forename: Kristin
authors.initials: K
authors.lastname: Watson
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Stein
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D014150:Antipsychotic Agents / Q000008:administration & dosage; D016009:Chi-Square Distribution; D016638:Critical Illness; D020927:Dexmedetomidine / Q000008:administration & dosage*; D023381:Endpoint Determination; D005260:Female; D006339:Heart Rate; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007022:Hypotension / Q000453:epidemiology; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage; D012042:Registries; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D000700:Analgesics; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol