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ORIGINAL ARTICLE
Year : 2016  |  Volume : 6  |  Issue : 3  |  Page : 109-114

Predictors of dexmedetomidine-associated hypotension in critically ill patients


1 Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
2 Department of Clinical Pharmacy, and Neurology and Neurosurgery, Methodist University Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
3 Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
4 Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA

Correspondence Address:
Anthony T Gerlach
Department of Pharmacy, The Ohio State University Wexner Medical Center, Room 368 Doan Hall, 410 West Tenth Avenue, Columbus, OH 43210
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.190656

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Background: Dexmedetomidine is commonly used for sedation in the Intensive Care Unit (ICU), and its use may be associated with hypotension. We sought to determine predictors of dexmedetomidine-associated hypotension. Methods: Retrospective, single-center study of 283 ICU patients in four adults ICUs over a 12 month period. Univariate analyses were performed to determine factors associated with dexmedetomidine-related hypotension. Risk factors significant at the 0.20 level in the univariate analysis were considered for inclusion into a step-wise multiple logistical regression model. Results: Hypotension occurred in 121 (42.8%) patients with a median mean arterial pressure (MAP) nadir of 54 mmHg. Univariate analyses showed an association between hypotension and age (P = 0.03), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (P = 0.02), baseline MAP (<0.001), admission to the cardiothoracic ICU (P = 0.05), history of coronary artery disease (P = 0.02), and postcardiac surgery (P = 0.0009). Admission to the medical ICU was associated with a decrease in development in hypotension (P = 0.03). There was a trend for hypotension with weight (P = 0.09) and history of congestive heart failure (P = 0.12) Only MAP prior to initiation (odds ratio [OR] 0.97, 95% confidence interval [95% CI] 0.95–0.99;P < 0.0001), APACHE II scores (OR 1.06, 95% CI 1.01–1.12;P= 0.017), and history of coronary artery disease (OR 0.48, 95% CI 0.26–0.90,P= 0.022) were independently associated with hypotension by multivariable analysis. Conclusions: Dexmedetomidine-associated hypotension is common. Preexisting low blood pressure, history of coronary artery disease, and higher acuity were identified as independent risk factors for dexmedetomidine-associated hypotension.


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