title: Predictors of dexmedetomidine-associated hypotension in critically ill patients.
abstract: BACKGROUND
  Dexmedetomidine is commonly used for sedation in the Intensive Care Unit (ICU), and its use may be associated with hypotension. We sought to determine predictors of dexmedetomidine-associated hypotension.
  
  
  METHODS
  Retrospective, single-center study of 283 ICU patients in four adults ICUs over a 12 month period. Univariate analyses were performed to determine factors associated with dexmedetomidine-related hypotension. Risk factors significant at the 0.20 level in the univariate analysis were considered for inclusion into a step-wise multiple logistical regression model.
  
  
  RESULTS
  Hypotension occurred in 121 (42.8%) patients with a median mean arterial pressure (MAP) nadir of 54 mmHg. Univariate analyses showed an association between hypotension and age (P= 0.03), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (P= 0.02), baseline MAP (<0.001), admission to the cardiothoracic ICU (P= 0.05), history of coronary artery disease (P= 0.02), and postcardiac surgery (P= 0.0009). Admission to the medical ICU was associated with a decrease in development in hypotension (P= 0.03). There was a trend for hypotension with weight (P= 0.09) and history of congestive heart failure (P= 0.12) Only MAP prior to initiation (odds ratio [OR] 0.97, 95% confidence interval [95% CI] 0.95-0.99;P< 0.0001), APACHE II scores (OR 1.06, 95% CI 1.01-1.12;P= 0.017), and history of coronary artery disease (OR 0.48, 95% CI 0.26-0.90,P= 0.022) were independently associated with hypotension by multivariable analysis.
  
  
  CONCLUSIONS
  Dexmedetomidine-associated hypotension is common. Preexisting low blood pressure, history of coronary artery disease, and higher acuity were identified as independent risk factors for dexmedetomidine-associated hypotension.
authors.affiliation: Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Gerlach
authors.affiliation: Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Blais
authors.affiliation: Department of Clinical Pharmacy, and Neurology and Neurosurgery, Methodist University Hospital, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: G Morgan
authors.initials: GM
authors.lastname: Jones
authors.affiliation: Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Burcham
authors.affiliation: Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA.
authors.forename: Stanislaw P
authors.initials: SP
authors.lastname: Stawicki
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Cook
authors.affiliation: Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Claire V
authors.initials: CV
authors.lastname: Murphy
keywords: Analgosedation; critically ill; dexmedetomidine; hypotension; sedation