Friday October 23, 2009
Dexmedetomidine (precedex) reduce total extubation time?

Giving a patient dexmedetomidine prior to removing respiratory ventilation support reduced the total extubation time, according to research presented at the American Society of Anesthesiologists (ASA) 2009 annual meeting held this week in New Orleans. Researchers also found using the sedative resulted in fewer ventilator days and more successful extubation.

“Currently, if a patient cannot be successfully extubated, no viable alternative exists aside from performing additional weaning attempts and, in some cases, a tracheotomy,” said lead author Julin F. Tang, MD, MS, FCCM, clinical professor, Department of Anesthesia and Perioperative Care at San Francisco General Hospital. “This is tremendously hard on the patient. Now, based on the results of this study, dexmedetomidine may be a viable option for patients who have failed previous attempts to remove the respiratory tubes because it appears to inhibit a stress response in the body that can make it difficult to extubate.”

The prospective, randomized, controlled, IRB-approved study, "Dexmedetomidine Facilitates Extubation in Agitated SICU Patients Failing Previous Weaning Attempts," was conducted among 20 critically ill, intensive care patients who had failed previous attempts to remove ventilation support.

Participants not in the control group received dexmedetomidine at 0.5 or 0.7 mcg/kg/hr. Background sedation and analgesia were gradually decreased in the treatment group, and aerosolized lidocaine was initiated prior to weaning. Shortly after dexmedetomidine infusion, pressure support ventilation (PSV) was initiated and patients were weaned and extubated. Researchers measured the medication treatment group’s condition by checking the subjects’ arterial blood gases at three different points throughout the trial.

Following extubation, the amount of time required to take the tube out was distinctly shorter in patients who received dexmedetomidine. Ventilator time was shorter in these patients, and the rate of successful extubation was higher in the treatment group than the control group.

“Although the study size was relatively small, these results suggest that dexmedetomidine infusion during the weaning process may help control those problems that cause weaning attempts to fail such as agitation, tachypnea, tachycardia, and hypertension,” said Tang. “If a patient has these reactions, the medical team must refrain from pulling out the ventilator tube and try again the next day, which adds to the patient’s hospital costs as well as stress level.”


References: Click to get article

1. Study on the Use of Dexmedetomidine to Facilitate Extubation in Surgical Intensive-Care-Unit Patients Who Failed Previous Weaning Attempts - clinicaltrials.gov

2. Use of dexmedetomidine to facilitate extubation in surgical ICU patients who failed previous weaning attempts following prolonged mechanical ventilation: A pilot study - Respir Care 2006;51 (5):492-496.

3. Feasibility of dexmedetomidine in facilitating extubation in the intensive care unit - Journal of Clinical Pharmacy and Therapeutics, Volume 33 Issue 1, Pages 25 - 30, Published Online: 17 Jan 2008