The Use of Dexmedetomidine in the Emergency Department: A Cohort Study

• Published in: The western journal of emergency medicine Vol. 22; no. 5; pp. 1202 - 1209
• Main Authors: Sinnott, Joseph, Holthaus, Christopher V, Ablordeppey, Enyo, Wessman, Brian T, Roberts, Brian W, Fuller, Brian M
• Format: Journal Article
• Language: English
• Published: United States University of California Digital Library - eScholarship 22.08.2021; Department of Emergency Medicine, University of California, Irvine School of Medicine; eScholarship Publishing, University of California
• Subjects: Adult; Aged; Analgesics, Non-Narcotic - administration & dosage; Analgesics, Non-Narcotic - adverse effects; Anesthesia; Bradycardia - chemically induced; Cardiac arrhythmia; Cohort analysis; Cohort Studies; Critical Care; Dexmedetomidine - administration & dosage; Dexmedetomidine - adverse effects; Drug-Related Side Effects and Adverse Reactions - epidemiology; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - adverse effects; Hypotension; Hypotension - chemically induced; Incidence; Male; Middle Aged; Respiration, Artificial; Respiratory Distress Syndrome - drug therapy; Respiratory failure; Retrospective Studies; United States; Ventilators; United States
• ISSN: 1936-900X; 1936-9018; 1936-9018
• DOI: 10.5811/WESTJEM.2021.4.50917

Management of sedation, analgesia, and anxiolysis are cornerstone therapies in the emergency department (ED). Dexmedetomidine (DEX), a central alpha-2 agonist, is increasingly being used, and intensive care unit (ICU) data demonstrate improved outcomes in patients with respiratory failure. However, there is a lack of ED-based data. We therefore sought to: 1) characterize ED DEX use; 2) describe the incidence of adverse events; and 3) explore factors associated with adverse events among patients receiving DEX in the ED. This was a single-center, retrospective, cohort study of consecutive ED patients administered DEX (January 1, 2017-July 1, 2019) at an academic, tertiary care ED with an annual census of ~90,000 patient visits. All included patients (n= 103) were analyzed for characterization of DEX use in the ED. The primary outcome was a composite of adverse events, bradycardia and hypotension. Secondary clinical outcomes included ventilator-, ICU-, and hospital-free days, and hospital mortality. To examine for variables associated with adverse events, we used a multivariable logistic regression model. We report on 103 patients. Dexmedetomidine was most commonly given for acute respiratory failure, including sedation for mechanical ventilation (28.9%) and facilitation of non-invasive ventilation (17.4%). Fifty-four (52.4%) patients experienced the composite adverse event, with hypotension occurring in 41 patients (39.8%) and bradycardia occurring in 18 patients (17.5%). Dexmedetomidine was stopped secondary to an adverse event in eight patients (7.8%). Duration of DEX use in the ED was associated with an increase adverse event risk (adjusted odds ratio, 1.004; 95% confidence interval, 1.001, 1.008). Dexmedetomidine is most commonly administered in the ED for patients with acute respiratory failure. Adverse events are relatively common, yet DEX is discontinued comparatively infrequently due to adverse events. Our results suggest that DEX could be a viable option for analgesia, anxiolysis, and sedation in ED patients.