scholarly journals A Single-Center Evaluation of Extended Infusion Piperacillin/Tazobactam for Empiric Treatment in the Intensive Care Unit

2020 ◽  
Vol 36 (5) ◽  
pp. 196-201
Author(s):  
Kendall Tucker ◽  
Molly Benning ◽  
Keenan Ryan ◽  
Carla Walraven ◽  
Bernadette Jakeman
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Chart Review ◽  
Patient Specific ◽  
Icu Patients ◽  
Intravenous Antibiotics ◽  
Average Patient ◽  
Dosing Regimens ◽  
Extended Infusion

Background: Piperacillin/tazobactam (PTZ) extended infusion (EI) is often used empirically in the intensive care unit (ICU). Gram-negative (GN) organisms with PTZ minimum inhibitory concentrations (MICs) >16/4 µg/mL are considered intermediate or resistant. Objective: The objective of this study was to evaluate MICs of GN isolates from the ICU to determine whether the hospital protocol for PTZ 3.375 g EI over 4 hours administered every 8 hours is an appropriate empiric regimen for ICU patients and to evaluate patient-specific risk factors associated with elevated MICs. Methods: All ICU patients admitted during 2017 with a confirmed GN organism from a non-urinary source were included for retrospective chart review. Patients with cystic fibrosis or cultures obtained >48 hours prior to ICU admission were excluded. Demographics, GN organism, culture source, risk factors for resistance, susceptibility profile, comorbidities, and creatinine clearance were collected. Appropriateness was defined as PTZ MIC ≤16/4 µg/mL in >80% of isolates. Results: Two hundred and thirty-one patients were included. The average patient was 56 years old. The majority of patients were white (64.1%) and male (69.7%). Pseudomonas aeruginosa (41%) was the most common organism isolated. Overall, 28% of GN isolates had MICs >16/4 µg/mL. Dialysis ( P = .01), intravenous antibiotics within 90 days ( P < .001), and presence of wounds/trauma ( P = .01) were associated with elevated MICs. Conclusion: Current PTZ EI 3.375 g dosing regimens may not provide adequate empiric coverage for some GN organisms in ICU patients, especially for those who have previously received intravenous antibiotics, are on dialysis, or have wounds/trauma.

scholarly journals Staphylococcus aureusNasal Colonization and Subsequent Infection in Intensive Care Unit Patients: Does Methicillin Resistance Matter?

2010 ◽  
Vol 31 (6) ◽  
pp. 584-591 ◽  
Author(s):  
Hitoshi Honda ◽  
Melissa J. Krauss ◽  
Craig M. Coopersmith ◽  
Marin H. Kollef ◽  
Amy M. Richmond ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Methicillin Resistance ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Patient Specific ◽  
Icu Patients ◽  
Icu Admission

Background.Staphylococcus aureusis an important cause of infection in intensive care unit (ICU) patients. Colonization with methicillin-resistantS. aureus(MRSA) is a risk factor for subsequentS. aureusinfection. However, MRSA-colonized patients may have more comorbidities than methicillin-susceptibleS. aureus(MSSA)-colonized or noncolonized patients and therefore may be more susceptible to infection on that basis.Objective.To determine whether MRSA-colonized patients who are admitted to medical and surgical ICUs are more likely to develop anyS. aureusinfection in the ICU, compared with patients colonized with MSSA or not colonized withS. aureus,independent of predisposing patient risk factors.Design.Prospective cohort study.Setting.A 24-bed surgical ICU and a 19-bed medical ICU of a 1,252-bed, academic hospital.Patients.A total of 9,523 patients for whom nasal swab samples were cultured forS. aureusat ICU admission during the period from December 2002 through August 2007.Methods.Patients in the ICU for more than 48 hours were examined for an ICU-acquired S.aureusinfection, defined as development ofS. aureusinfection more than 48 hours after ICU admission.Results.S. aureuscolonization was present at admission for 1,433 (27.8%) of 5,161 patients (674 [47.0%] with MRSA and 759 [53.0%] with MSSA). An ICU-acquiredS. aureusinfection developed in 113 (2.19%) patients, of whom 75 (66.4%) had an infection due to MRSA. Risk factors associated with an ICU-acquiredS. aureusinfection included MRSA colonization at admission (adjusted hazard ratio, 4.70 [95% confidence interval, 3.07-7.21]) and MSSA colonization at admission (adjusted hazard ratio, 2.47 [95% confidence interval, 1.52-4.01]).Conclusion.ICU patients colonized with S.aureuswere at greater risk of developing aS. aureusinfection in the ICU. Even after adjusting for patient-specific risk factors, MRSA-colonized patients were more likely to developS. aureusinfection, compared with MSSA-colonized or noncolonized patients.

scholarly journals Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage?

2021 ◽  
Vol 9 (7) ◽  
pp. 1505
Author(s):  
Claire Roger ◽  
Benjamin Louart
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Manifestations ◽  
Acute Interstitial Nephritis ◽  
Convulsive Status Epilepticus ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Drug Induced ◽  
Icu Patients

Beta-lactams are the most commonly prescribed antimicrobials in intensive care unit (ICU) settings and remain one of the safest antimicrobials prescribed. However, the misdiagnosis of beta-lactam-related adverse events may alter ICU patient management and impact clinical outcomes. To describe the clinical manifestations, risk factors and beta-lactam-induced neurological and renal adverse effects in the ICU setting, we performed a comprehensive literature review via an electronic search on PubMed up to April 2021 to provide updated clinical data. Beta-lactam neurotoxicity occurs in 10–15% of ICU patients and may be responsible for a large panel of clinical manifestations, ranging from confusion, encephalopathy and hallucinations to myoclonus, convulsions and non-convulsive status epilepticus. Renal impairment, underlying brain abnormalities and advanced age have been recognized as the main risk factors for neurotoxicity. In ICU patients, trough concentrations above 22 mg/L for cefepime, 64 mg/L for meropenem, 125 mg/L for flucloxacillin and 360 mg/L for piperacillin (used without tazobactam) are associated with neurotoxicity in 50% of patients. Even though renal complications (especially severe complications, such as acute interstitial nephritis, renal damage associated with drug induced hemolytic anemia and renal obstruction by crystallization) remain rare, there is compelling evidence of increased nephrotoxicity using well-known nephrotoxic drugs such as vancomycin combined with beta-lactams. Treatment mainly relies on the discontinuation of the offending drug but in the near future, antimicrobial optimal dosing regimens should be defined, not only based on pharmacokinetics/pharmacodynamic (PK/PD) targets associated with clinical and microbiological efficacy, but also on PK/toxicodynamic targets. The use of dosing software may help to achieve these goals.

Risk Factors Associated With Resistance to Ciprofloxacin in Clinical Bacterial Isolates From Intensive Care Unit Patients

2007 ◽  
Vol 28 (3) ◽  
pp. 331-336 ◽  
Author(s):  
Phillip D. Levin ◽  
Robert A. Fowler ◽  
Cameron Guest ◽  
William J. Sibbald ◽  
Alex Kiss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Prior Treatment ◽  
Bacterial Isolates ◽  
Icu Patients ◽  
Gram Negative ◽  
Factors Associated ◽  
Icu Admission ◽  
Ciprofloxacin Resistance

Objective.To determine risk factors and outcomes associated with ciprofloxacin resistance in clinical bacterial isolates from intensive care unit (ICU) patients.Design.Prospective cohort study.Setting.Twenty-bed medical-surgical ICU in a Canadian tertiary care teaching hospital.Patients.All patients admitted to the ICU with a stay of at least 72 hours between January 1 and December 31, 2003.Methods.Prospective surveillance to determine patient comorbidities, use of medical devices, nosocomial infections, use of antimicrobials, and outcomes. Characteristics of patients with a ciprofloxacin-resistant gram-negative bacterial organism were compared with characteristics of patients without these pathogens.Results.Ciprofloxacin-resistant organisms were recovered from 20 (6%) of 338 ICU patients, representing 38 (21%) of 178 nonduplicate isolates of gram-negative bacilli. Forty-nine percent ofPseudomonas aeruginosaisolates and 29% ofEscherichia coliisolates were resistant to ciprofloxacin. In a multivariate analysis, independent risk factors associated with the recovery of a ciprofloxacin-resistant organism included duration of prior treatment with ciprofloxacin (relative risk [RR], 1.15 per day [95% confidence interval {CI}, 1.08-1.23];P< .001), duration of prior treatment with levofloxacin (RR, 1.39 per day [95% CI, 1.01-1.91];P= .04), and length of hospital stay prior to ICU admission (RR, 1.02 per day [95% CI, 1.01-1.03];P= .005). Neither ICU mortality (15% of patients with a ciprofloxacin-resistant isolate vs 23% of patients with a ciprofloxacin-susceptible isolate;P= .58 ) nor in-hospital mortality (30% vs 34%;P= .81 ) were statistically significantly associated with ciprofloxacin resistance.Conclusions.ICU patients are at risk of developing infections due to ciprofloxacin-resistant organisms. Variables associated with ciprofloxacin resistance include prior use of fluoroquinolones and duration of hospitalization prior to ICU admission. Recognition of these risk factors may influence antibiotic treatment decisions.

Abstract 15875: Prediction of Intensive Care Unit Admission Among Patients Hospitalized for COVID-19: The Intermountain Coronavirus ICU Risk Model (CORONA-ICU)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Heidi T May ◽  
Joseph B Muhlestein ◽  
Benjamin D Horne ◽  
Kirk U Knowlton ◽  
Tami L Bair ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Risk Prediction ◽  
Prediction Models ◽  
Risk Model ◽  
Beta Blockers ◽  
Risk Scores ◽  
Channel Blockers ◽  
Icu Patients

Background: Treatment for COVID-19 has created surges in hospitalizations, intensive care unit (ICU) admissions, and the need for advanced medical therapy and equipment, including ventilators. Identifying patients early on who are at risk for more intensive hospital resource use and poor outcomes could result in shorter hospital stays, lower costs, and improved outcomes. Therefore, we created clinical risk scores (CORONA-ICU and -ICU+) to predict ICU admission among patients hospitalized for COVID-19. Methods: Intermountain Healthcare patients who tested positive for SARS-CoV-2 and were hospitalized between March 4, 2020 and June 8, 2020 were studied. Derivation of CORONA-ICU risk score models used weightings of commonly collected risk factors and medicines. The primary outcome was admission to the ICU during hospitalization, and secondary outcomes included death and ventilator use. Results: A total of 451 patients were hospitalized for a SARS-CoV-2 positive infection, and 191 (42.4%) required admission to the ICU. Patients admitted to the ICU were older (58.2 vs. 53.6 years), more often male (61.3% vs. 48.5%), and had higher rates of hyperlipidemia, hypertension, diabetes, and peripheral arterial disease. ICU patients more often took ACE inhibitors, beta-blockers, calcium channel blockers, diuretics, and statins. Table 1 shows variables that were evaluated and included in the CORONA-ICU risk prediction models. Models adding medications (CORONA-ICU+) improved risk-prediction. Though not created to predict death and ventilator use, these models did so with high accuracy (Table 2). Conclusion: The CORONA-ICU and -ICU+ models, composed of commonly collected risk factors without or with medications, were shown to be highly predictive of ICU admissions, death, and ventilator use. These models can be efficiently derived and effectively identify high-risk patients who require more careful observation and increased use of advanced medical therapies.

scholarly journals Vasopressin for Septic Shock in a Medical-Surgical Intensive Care Unit

2020 ◽  
Vol 73 (3) ◽  
Author(s):  
Arpita Patel ◽  
Arielle Beauchesne ◽  
Nina Bredenkamp ◽  
Rumi McGloin ◽  
Sarah N Stabler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Retrospective Chart Review ◽  
Patient Specific ◽  
Surgical Intensive Care Unit ◽  
Prescribing Practices ◽  
Surgical Intensive Care ◽  
Choc Septique ◽  
The Mean

ABSTRACTBackground: Critically ill patients often need vasopressors to treat hypotension related to septic shock and to maintain adequate systemic perfusion. Although the 2017 guidelines of the Surviving Sepsis Campaign recommend norepinephrine as first-line therapy, they also state that vasopressin may be considered as an adjunctive agent for patients with refractory shock. Limited evidence is available for directing optimal administration of vasopressin. As such, prescribing practices are not standardized and may vary according to the particular clinician, the clinical scenario, and various patient-specific factors.Objectives:To review the current practice of administering concomitant norepinephrine and vasopressin therapy to patients with septic shock, to describe variability in vasopressin administration, and to evaluate effects on patient safety in a medical-surgical intensive care unit (ICU).Methods: This single-centre retrospective chart review involved 100 adult patients admitted to the ICU who received vasopressin and norepinephrine for septic shock between April and December 2017. The data were analyzed with descriptive statistics.Results: The mean time to initiation of vasopressin was 12.0 (standard deviation [SD] 21.6) h after initiation of norepinephrine. The mean dose of norepinephrine at the time of vasopressin initiation was 29.5 (SD 19.7) μg/min. The mean vasopressin dose prescribed was 0.04 (SD 0.03) units/min, with a range of tapering and discontinuation regimens. The mean duration of vasopressin therapy was 49.1 (SD 65.2) h, and vasopressin was discontinued before norepinephrine in 49 of the patients. A total of 60 hypotensive events occurred after vasopressor discontinuation and were more common when vasopressin was discontinued before norepinephrine.Conclusions: Vasopressin dosing was comparable to that reported elsewhere; however, discontinuation practices were inconsistent. These results show that variability in the literature supporting vasopressin use has led to variability in vasopressin administration and discontinuation practices; however, correlation with improvement in clinical outcomes, such as mortality or ICU length of stay, is unclear, and further research is required to determine the ideal approach to vasopressin use.RÉSUMÉContexte : Les patients gravement malades nécessitent souvent un vasopresseur pour traiter l’hypotension liée au choc septique et pour préserver une perfusion systémique adéquate. Bien que les directives de 2017 de la campagne Surviving Sepsis recommandent la norepinephrine en guise de thérapie de première ligne, elles précisent également que la vasopressine pourrait être envisagée comme agent d’appoint pour les patients présentant des chocs réfractaires. Seules des données probantes limitées soutiennent l’administration optimale de la vasopressine. Les pratiques de prescription proprement dites ne sont pas standardisées et peuvent varier selon le clinicien, le scénario clinique et les divers facteurs particuliers au patient.Objectifs : Examiner la pratique actuelle d’administration de la norépinephrine concomitante à la thérapie de vasopressine aux patients ayant subi un choc septique, décrire la variabilité d’administration de la vasopressine et évaluer les effets sur la sécurité du patient dans une unite de soins intensifs (USI) médicale-chirurgicale.Méthodes : Cet examen rétrospectif unicentrique des dossiers portait sur 100 patients adultes admis dans une USI, ayant reçu de la vasopressine et de la norépinephrine en réponse à des chocs septiques entre avril et décembre 2017. Les données ont été analysées à l’aide de statistiques descriptives.Résultats : Le temps moyen du début de l’administration de la vasopressine était de 12 h (écart type [É.T.] 21,6) après le début de l’administration de la norépinephrine. La dose moyenne de norepinephrine au moment du début de l’administration de la vasopressine était de 29,5 (É.T. 19,7) μg/min. La dose moyenne de vasopressine prescrite était de 0,04 (É.T. 0,03) unités/min, avec une gamme de posologies dégressives et d’abandons. La durée moyenne de la thérapie à la vasopressine était de 49,1 h (É.T. 65,2), et 49 patients ont abandonné la vasopressine avant l’abandon de la norépinephrine. Un total de 60 événements hypotenseurs se sont produits après l’abandon du vasopresseur et ils étaient plus fréquents lors de l’abandon de la vasopressine précédant celui de la norépinephrine.Conclusions : Le dosage de vasopressine était comparable à celui indiqué dans d’autres études; cependant, les pratiques d’abandon étaient incohérentes. Ces résultats démontrent que l’indétermination de l’information publiée dans la littérature soutenant l’utilisation de la vasopressine a entraîné une fluctuation dans l’administration de la vasopressine et des pratiques d’abandon; cependant, la corrélation entre l’usage de la vasopressine et l’amélioration des résultats cliniques, comme la mortalité ou la durée du séjour en USI, n’est pas claire, et davantage de recherches sont nécessaires pour déterminer l’approche idéale à adopter à l’égard de l’utilisation de la vasopressine.

scholarly journals Prognostic Assessment of COVID-19 in the Intensive Care Unit by Machine Learning Methods: Model Development and Validation

10.2196/23128 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e23128
Author(s):  
Pan Pan ◽  
Yichao Li ◽  
Yongjiu Xiao ◽  
Bingchao Han ◽  
Longxiang Su ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Prediction Model ◽  
Risk Prediction ◽  
Risk Prediction Model ◽  
Data Set ◽  
Icu Patients ◽  
Potential Risk Factors

Background Patients with COVID-19 in the intensive care unit (ICU) have a high mortality rate, and methods to assess patients’ prognosis early and administer precise treatment are of great significance. Objective The aim of this study was to use machine learning to construct a model for the analysis of risk factors and prediction of mortality among ICU patients with COVID-19. Methods In this study, 123 patients with COVID-19 in the ICU of Vulcan Hill Hospital were retrospectively selected from the database, and the data were randomly divided into a training data set (n=98) and test data set (n=25) with a 4:1 ratio. Significance tests, correlation analysis, and factor analysis were used to screen 100 potential risk factors individually. Conventional logistic regression methods and four machine learning algorithms were used to construct the risk prediction model for the prognosis of patients with COVID-19 in the ICU. The performance of these machine learning models was measured by the area under the receiver operating characteristic curve (AUC). Interpretation and evaluation of the risk prediction model were performed using calibration curves, SHapley Additive exPlanations (SHAP), Local Interpretable Model-Agnostic Explanations (LIME), etc, to ensure its stability and reliability. The outcome was based on the ICU deaths recorded from the database. Results Layer-by-layer screening of 100 potential risk factors finally revealed 8 important risk factors that were included in the risk prediction model: lymphocyte percentage, prothrombin time, lactate dehydrogenase, total bilirubin, eosinophil percentage, creatinine, neutrophil percentage, and albumin level. Finally, an eXtreme Gradient Boosting (XGBoost) model established with the 8 important risk factors showed the best recognition ability in the training set of 5-fold cross validation (AUC=0.86) and the verification queue (AUC=0.92). The calibration curve showed that the risk predicted by the model was in good agreement with the actual risk. In addition, using the SHAP and LIME algorithms, feature interpretation and sample prediction interpretation algorithms of the XGBoost black box model were implemented. Additionally, the model was translated into a web-based risk calculator that is freely available for public usage. Conclusions The 8-factor XGBoost model predicts risk of death in ICU patients with COVID-19 well; it initially demonstrates stability and can be used effectively to predict COVID-19 prognosis in ICU patients.

Impact of Early Reinitiation of Neuropsychiatric Medications on Agitation and Delirium in the Intensive Care Unit: A Retrospective Study

2020 ◽  
Vol 55 (1) ◽  
pp. 15-24
Author(s):  
Michaelia D. Cucci ◽  
Brittany S. Cunningham ◽  
Jaimini S. Patel ◽  
Alan T. Shimer ◽  
Dania I. Mofleh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Group Versus ◽  
Care Hospital ◽  
Icu Patients ◽  
Independent Risk Factors ◽  
The Impact

Background: Approximately 17% of intensive care unit (ICU) patients are prescribed at least 1 home neuropsychiatric medication (NPM). When abruptly discontinued, withdrawal symptoms may occur manifesting as agitation or delirium in the ICU setting. Objective: To evaluate the impact of early reinitiation of NPMs. Methods: This was a retrospective, observational cohort of adult ICU patients in a tertiary care hospital. Patients were included if admitted to the ICU and prescribed a NPM prior to arrival. Study groups were based on the timing of reinitiation of at least 50% of NPMs: ≤72 hours (early group) versus >72 hours (late group). Results: The primary outcome was the proportion of patients with at least 1 agitation or delirium episode in the first 72 hours. Agitation and delirium were defined as at least 1 RASS assessment between +2 to +4 and a positive CAM-ICU assessment, respectively. A total of 300 patients were included, with 187 (62%) and 113 (38%) in the early and late groups, respectively. There was no difference in agitation or delirium (late 54 [48%] vs early 62 [33%]; adjusted odds ratio [aOR] = 1.5; 95% CI = 0.8-2.8; P = 0.193). Independent risk factors found to be associated with the primary outcome were restraints (aOR = 12.9; 95% CI = 6.9-24.0; P < 0.001) and benzodiazepines (BZDs; aOR = 2.0; 95% CI = 1.0-3.7; P = 0.038). Conclusions: After adjustment for baseline differences, there was no difference in agitation or delirium. Independent risk factors were restraint use and newly initiated BZDs.

Evaluation of Neuroleptic Utilization in the Intensive Care Unit During Transitions of Care

2016 ◽  
Vol 32 (2) ◽  
pp. 158-162 ◽  
Author(s):  
Brian Gilbert ◽  
James R. Morales ◽  
Randi J. Searcy ◽  
Donald W. Johnson ◽  
Jason A. Ferreira
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Chart Review ◽  
Transitions Of Care ◽  
Drug Screen ◽  
Urine Drug Screen ◽  
Neuroleptic Medication ◽  
Factors Associated ◽  
Urine Drug

Purpose: The purpose of this study was to identify risk factors associated with inappropriate continuation of neuroleptics postdischarge from the intensive care unit (ICU) and hospital. Materials and Methods: A retrospective chart review was performed including all patients greater than 18 years of age who received neuroleptic medications in an ICU. Results: One hundred sixty-one patients were included during the 12- month study period. There were 85 (53%) patients discharged from the ICU with inappropriate continuation of a neuroleptic medication. There were 54 (34%) patients discharged from the hospital with inappropriate continuation of a neuroleptic medication. Patients were more likely to be discharged from the ICU with an inappropriate neuroleptic if they were prescribed multiple neuroleptics ( P = .02), did not have a urine drug screen collected at admission ( P = .023), or if trazodone was utilized in their therapy ( P = .004). Patients were more likely to be discharged from the hospital with a neuroleptic if they had multiple neuroleptic orders ( P = .0001) or if trazodone was utilized in their therapy ( P = .0023). Conclusion: Risk factors associated with the continuation of inappropriate neuroleptic medications upon discharge from the ICU or the hospital include multiple neuroleptic medications prescribed, the lack of a urine drug screen upon admission, and the utilization of trazodone.

Standard- versus High-Dose Dexmedetomidine for Sedation in the Intensive Care Unit

2021 ◽  
pp. 001857872110295
Author(s):  
Megan Van Berkel Patel ◽  
Spencer Bolton ◽  
Cassie Hamilton
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Neuromuscular Blocking ◽  
High Dose ◽  
Icu Patients ◽  
Academic Medical

Background: Dexmedetomidine is a commonly used sedative in the intensive care unit (ICU), however the use of higher, off label dosing has yet to be elucidated. A dose limitation protocol was implemented at our institution allowing for comparison of dexmedetomidine doses. Objective: The purpose of this study is to evaluate time spent within goal Richmond Agitation Sedation Scale (RASS) range with standard-dosing of dexmedetomidine ≤1 mcg/kg/hour (SD group) compared to high-dose >1 mcg/kg/hour (HD group). Secondary outcomes included days requiring mechanical ventilation, concomitant sedation, and incidence of hypotension or bradycardia. Methods: This retrospective chart review of adult ICU patients at a single academic medical center included patients who required at least 24 hours of mechanical ventilation and received dexmedetomidine monotherapy for at least 4 hours. Patients were excluded for intubations at an outside hospital, continuous neuromuscular blocking infusions, or Glasgow Coma Score ≤4. Results: A total of 144 patients met inclusion criteria (n = 121 SD group and n = 23 HD group). The SD group spent a greater time within goal RASS range compared to the HD group (84.5% [IQR 47–100] vs 45.5% [IQR 30.1–85.4], P = .013). The SD group also had shorter durations of both dexmedetomidine infusion and mechanical ventilation, and required less concomitant sedation. There was no difference in hypotension or bradycardia. Conclusion: This study further adds to the literature that administration of high-dose dexmedetomidine does not appear to confer additional benefit over standard doses for ICU patients requiring mechanical ventilation. Application of this data may support lower institutional maximum doses.

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