Experienced use of dexmedetomidine in the intensive care unit: A report of a structured consensus

Daniela Pasero, Fabio Sangalli, Massimo Baiocchi, Ilaria Blangetti, Sergio Cattaneo, Gianluca Paternoster, Marco Moltrasio, Elisabetta Auci, Patrizia Murrino, Francesco Forfori, Ester Forastiere, Maria Giovanna De Cristofaro, Giorgio Deste, Paolo Feltracco, Flavia Petrini, Luigi Tritapepe, Massimo Girardis

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Management of pain, agitation and delirium (PAD) remains to be a true challenge in critically ill patients. The pharmacological proprieties of dexmedetomidine (DEX) make it an ideal candidate drug for light and cooperative sedation, but many practical questions remain unanswered. This structured consensus from 17 intensivists well experienced on PAD management and DEX use provides indications for the appropriate use of DEX in clinical practice. Methods: A modified RAND/UCLA appropriateness method was used. In four predefined patient populations, the clinical scenarios do not properly cope by the current recommended pharmacological strategies (except DEX), and the possible advantages of DEX use were identified and voted for agreement, after reviewing literature data. Results: Three scenarios in medical patients, five scenarios in patients with acute respiratory failure undergoing non-invasive ventilation, three scenarios in patients with cardiac surgery in the early postoperative period and three scenarios in patients with overt delirium were identified as challenging with the current PAD strategies. In these scenarios, the use of DEX was voted as potentially useful by most of the panellists owing to its specific pharmacological characteristics, such as conservation of cognitive function, lack of effects on the respiratory drive, low induction of delirium and analgesia effects. Conclusion: DEX might be considered as a first-line sedative in different scenarios even though conclusive data on its benefits are still lacking.

Original languageEnglish
Pages (from-to)176-183
Number of pages8
JournalTurk Anesteziyoloji ve Reanimasyon Dernegi Dergisi
Volume46
Issue number3
DOIs
Publication statusPublished - Jan 1 2018

Keywords

  • Analgesia
  • Critically ill patients
  • Delirium
  • Intensive care
  • Sedation

ASJC Scopus subject areas

  • Emergency Medicine
  • Anesthesiology and Pain Medicine

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