Peyton M Kurtz, Jason VanLandingham, Michael Cormican, Kyle Gibson, Leslie Roebuck
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引用次数: 0
Abstract
Background: Dexmedetomidine is an α-2 receptor agonist commonly used as a continuous infusion for sedation and analgesia; however, dose-dependent hypotension may limit its utility. Despite its widespread use, there is no consensus on appropriate dosing and titration.
Objective: The objective of this study was to determine whether a dexmedetomidine dosing and titration protocol is associated with decreased rates of hypotension in trauma patients.
Methods: This pre-post intervention study took place at a Level II trauma center in the Southeastern United States from August 2021 to March 2022 and included patients admitted by the trauma service to either the surgical trauma intensive care unit or intermediate care unit and received dexmedetomidine for greater than or equal to 6 hours. Patients were excluded if they were hypotensive or on vasopressors at baseline. The primary outcome was incidence of hypotension. Secondary outcomes included dosing and titration practices, initiation of a vasopressor, incidence of bradycardia, and time to goal Richmond Agitation Sedation Scale (RASS) score.
Results: Fifty-nine patients met inclusion criteria: 30 in the pre-intervention group and 29 in the post-intervention group. Protocol adherence in the post group was 34% with a median of one violation per patient. Rates of hypotension were similar between the groups (60% vs. 45%, p = .243) but significantly lower in the post group patients with zero protocol violations (60% vs. 20%, p = .029). The post group also had a significantly lower maximal dose (1.1 vs. 0.7 μg/kg/hr, p < .001). There were no significant differences in the initiation of a vasopressor, incidence of bradycardia, or time to goal RASS.
Conclusion: Adherence to a dexmedetomidine dosing and titration protocol significantly decreased incidence of hypotension and maximal dexmedetomidine dose without increasing time to goal RASS score in critically ill trauma patients.
期刊介绍：
Journal of Trauma Nursing (JTN) is the official journal of the Society of Trauma Nurses.
The Society of Trauma Nurses believes that trauma is a disease impacting patients through the continuum of care. The mission of STN is to ensure optimal trauma care through education, collaboration, leadership and membership engagement. As the official publication of the Society of Trauma Nurses, the Journal of Trauma Nursing supports the STN’s strategic goals of effective communication, education and patient advocacy with original, peer-reviewed, research and evidence-based articles and information that reflect the highest standard of collaborative care for trauma patients.
The Journal of Trauma Nursing, through a commitment to editorial excellence, implements STN’s vision to improve practice and patient outcomes and to become the premiere global nursing organization across the trauma continuum.
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