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Predictors of Bradycardia with Dexmedetomidine Use
Critical Care Medicine ; 51(1 Supplement):502, 2023.
Article in English | EMBASE | ID: covidwho-2190654
ABSTRACT

INTRODUCTION:

Although dexmedetomidine is a widely used sedative in the ICU, risk factors for bradycardia associated with dexmedetomidine use are not well characterized. Identifying factors that place a patient at increased risk for bradycardia with dexmedetomidine use may help guide interventions or limit complications associated with the medication's negative chronotropic effects. The aim of this analysis is to determine risk factors for development of bradycardia with dexmedetomidine use. METHOD(S) This single center, retrospective nested casecontrol included adult patients in cardiac and non-cardiac intensive care units with an intravenous dexmedetomidine duration of at least 1 hour. A univariate analysis was used to compare patients with and without bradycardia with dexmedetomidine use, and a predictive model was used to evaluate factors associated with bradycardia. Step-down backward variable selection was used based on Akaike's Information Criterion (AIC) and Bayesian Information Criteria (BIC) to identify the final model. The discriminatory power and absolute predictive ability of the final model was evaluated by the concordance index (c-index), which was internal validated by bootstrapping. Multiple imputation was performed before model selection to fill in missing values in pulse at initiation and Child Pugh Score before modeling. RESULT(S) Of the 1,838 patients receiving dexmedetomidine, 110 patients (6.0%) developed bradycardia within 72 hours of initiation. In patients that experienced bradycardia, 31 (28.1%) required an intervention. The initial full predictive model for bradycardia included age, sex, BMI, COVID19 positive test, hypothermia, pulse at initiation, ICU location (Cardiac vs non-cardiac), Child Pugh Score, use of fentanyl and propofol. Step-down backward variable selection identified 4 predictors in the final model, including COVID positive test, hypothermia, pulse at initiation, and ICU location. The final model achieved a good performance in discriminatory capability (c-index 0.758, 95%CI 0.713-0.806) using the smallest number of predictors. CONCLUSION(S) Patients with COVID-19, hypothermia, non-cardiac ICU locations and lower pulse at initiation are at increased odds of developing bradycardia. Recognition of risk may be used to guide monitoring or alternative sedation strategies.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Prognostic study Language: English Journal: Critical Care Medicine Year: 2023 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Prognostic study Language: English Journal: Critical Care Medicine Year: 2023 Document Type: Article