Prolonged infusions of dexmedetomidine in critically ill patients.

PURPOSE: The efficacy and safety of dexmedetomidine when used longer than the manufacturer-recommended 24 hours were evaluated.
SUMMARY: Dexmedetomidine is the newest agent available for use in the critical care setting to induce and maintain sedation and analgesia. However, concerns over efficacy and safety during prolonged administration are a limiting factor for use in this patient population. A literature review was conducted to assess the clinical evidence regarding the efficacy and safety of dexmedetomidine for longer than 24 hours. A total of 11 studies were identified. Of these trials, 6 included adult patients and 5 included pediatric patients. Of the 6 adult trials, 3 comparative trials demonstrated a similar efficacy with benzodiazepines (i.e., midazolam and lorazepam) or propofol, with a reduction in the incidence of delirium and coma associated with dexmedetomidine. In noncomparative trials, dexmedetomidine was efficacious in achieving sedation goals with only mild adverse effects. In the 5 pediatric trials evaluated, efficacy to achieve a target sedation scale score could not be assessed, as most studies did not use validated sedation scales to measure goal sedation. Alternatively, the safety of dexmedetomidine has been demonstrated throughout an extended duration of use. In all of the studies evaluated, dexmedetomidine was associated with bradycardia; however, there were no reports of withdrawal effects, including rebound tachycardia and hypertension, upon discontinuation of dexmedetomidine infusion.
CONCLUSION: Dexmedetomidine is an alternative to traditional sedatives and analgesics in critically ill patients. The safety and efficacy of dexmedetomidine in adults likely persist beyond 24 hours, without the emergence of rebound effects after discontinuation.