title: Dexmedetomidine for Refractory Intracranial Hypertension.
abstract: Dexmedetomidine (DEX) is a selective α2adrenergic agonist that is commonly used for sedation in the intensive care unit (ICU). The role of DEX for adjunctive treatment of refractory intracranial hypertension is poorly defined. The primary objective of this study was to determine the effect of DEX on the need for rescue therapy (ie, hyperosmolar boluses, extraventricular drain [EVD] drainages) for refractory intracranial hypertension. Secondary objectives included the number of intracranial pressure (ICP) excursions, bradycardic, hypotensive, and compromised cerebral perfusion pressure episodes. This retrospective cohort study evaluated patients admitted to the neurosurgical ICU from August 1, 2009, to July 29, 2015, and who received DEX for refractory intracranial hypertension. The objectives were compared between the 2 time periods-before (pre-DEX) and during therapy (DEX). Twenty-three patients with 26 episodes of refractory intracranial hypertension met the inclusion criteria. The number of hyperosmolar boluses was decreased after DEX therapy was initiated. Mannitol boluses required were statistically reduced (1 vs 0.5, P = .03); however, reduction in hypertonic boluses was not statistically significant (1.3 vs 0.9, P = .2). The mean number of EVD drainages per 24 hours was not significantly different between the time periods (15.7 vs 14.0, P = .35). The rate of ICP excursions did not differ between the 2 groups (24.3 vs 22.5, P = .62). When compared to pre-DEX data, there was no difference in the median number of hypotensive (0 vs 0), bradycardic (0 vs 0), or compromised cerebral perfusion pressure episodes (0.5 vs 1.0). Dexmedetomidine may avoid increases in the need for rescue therapy when used as an adjunctive treatment of refractory intracranial hypertension without compromising hemodynamics.
authors.affiliation: 1 Department of Pharmacy, University of California Davis Medical Center, Sacramento, CA, USA.
authors.forename: Kendra J
authors.initials: KJ
authors.lastname: Schomer
authors.affiliation: 2 Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, USA.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Sebat
authors.affiliation: 2 Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, USA.
authors.forename: Jason Y
authors.initials: JY
authors.lastname: Adams
authors.affiliation: 1 Department of Pharmacy, University of California Davis Medical Center, Sacramento, CA, USA.
authors.forename: Jeremiah J
authors.initials: JJ
authors.lastname: Duby
authors.affiliation: 3 Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, CA, USA.
authors.forename: Kiarash
authors.initials: K
authors.lastname: Shahlaie
authors.affiliation: 1 Department of Pharmacy, University of California Davis Medical Center, Sacramento, CA, USA.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Louie
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy*; D020927:Dexmedetomidine / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000494:pharmacology*; D016879:Salvage Therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D012462:Saline Solution, Hypertonic; D020927:Dexmedetomidine
keywords: adult brain injury; clinical management of CNS injury; head trauma; intracranial pressure; traumatic brain injury