title: A Pilot Study Implementing a Protocol Using Dexmedetomidine as a Safe Alternative to Traditional Sedation to Decrease Ventilator Days for Patients Difficult to Extubate.
abstract: BACKGROUND
  Traditional sedation for mechanically ventilated patients causes delirium, which increases the patients' length of stay while hospitalized. When extubation is attempted, these medications must be discontinued because of the side effect of respiratory depression, leaving patients anxious and agitated, delaying extubation and prolonging the need for mechanical ventilation. Dexmedetomidine is a safe alternative sedative that does not cause delirium or respiratory depression. During the weaning process, dexmedetomidine can be continued, allowing the patient to remain calm and successfully extubated.
  
  
  OBJECTIVE
  The aim of this study is to decrease the length of stay for mechanically ventilated patients by implementing a dexmedetomidine protocol for difficult-to-extubate patients during the weaning process.
  
  
  METHODS
  A preintervention/postintervention design pilot study was done comparing the patient mean of length of stay on mechanical ventilation. A Mann-Whitney U test was used because of the small sample size.
  
  
  RESULTS
  Over the 3-month implementation period, 15 patients received dexmedetomidine. None of the patients experienced adverse reactions while on dexmedetomidine. There was a trend of decreasing mechanical ventilation length of stay but no significant difference was noted between the preimplementation and postimplementation groups.
  
  
  CONCLUSIONS
  Dexmedetomidine was a safe alternative to traditional sedation for difficult-to-extubate patients when a bolus dose was not given.
authors.affiliation: Susan E. Becker, DNP, RN, CNS, CCRN, CCNS, is affiliated with the Duke University, Durham, North Carolina. She is an Assistant Professor of Nursing at the Malek School of Health Professionals of Marymount University, Virginia. She completed her DNP at Duke University in 2013 after finishing her BSN and MSN/CNS at George Mason University. Her research interests include intensive care and educational issues.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Becker
mesh_terms: D003693:Delirium; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012121:Respiration, Artificial; D015300:Ventilator Weaning
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine