ICU sedation with dexmedetomidine after severe traumatic brain injury

Abstract

Objective

To comprehensively describe the use of dexmedetomidine in a single institutional series of adult ICU patients with severe TBI. We describe the dexmedetomidine dosage and infusion times, as well as the physiological parameters, neurological status, and daily narcotic requirements before, during, and after dexmedetomidine infusion.

Methods

We identified 85 adult patients with severe TBI who received dexmedetomidine infusions in the Trauma ICU at Vanderbilt University Medical Center between 2006 and 2010. Demographic, hemodynamic, narcotic use, and sedative use data were systematically obtained from the medical record and analyzed for changes associated with dexmedetomidine infusion.

Results

During infusion with dexmedetomidine, narcotic and sedative use decreased significantly (p<.001 and p<.05). Median MAP, SBP, DBP, and HR also decreased significantly during infusion when compared to pre-infusion values (p<.001). Despite the use of dexmedetomidine, RASS and GCS scores improved from pre-infusion to infusion time periods.

Conclusions

Our findings demonstrate that initiation of dexmedetomidine infusion is not associated with a decline in neurological functioning in adults with severe TBI. Although there was an observed decrease in hemodynamic parameters during infusion with dexmedetomidine, the change was not clinically significant, and the requirements for narcotics and additional sedatives were minimized.