The following is a summary of “Association of Early Dexmedetomidine Utilization With Clinical and Functional Outcomes Following Moderate-Severe Traumatic Brain Injury: A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study,” published in the April 2024 issue of Critical Care by Liu et al.
Researchers conducted a retrospective study to examine initial sedation patterns along with the association of dexmedetomidine among mechanically ventilated patients with moderate-severe traumatic brain injury (msTBI)
They used propensity-weighted models to examine the association of early dexmedetomidine exposure within the first 5 days of ICU admission with the primary outcome of the 6-month Glasgow Outcomes Scale Extended (GOS-E) and various secondary outcomes. The subject cohort consisted of 352 individuals requiring mechanical ventilation within 24 hours of admission. Initial sedative medication types and frequencies were reported.
The results showcased using initial sedative medication propofol for 240 patients, midazolam for 59 patients, ketamine for 6 patients, dexmedetomidine for 3 patients, and 43 patients never received continuous sedation. Among patients receiving early dexmedetomidine (22%), no significant improvement in 6-month GOS-E was observed compared to unexposed patients (OR= 1.48; 95% CI, 0.98-2.25), However, It correlated with lower Disability Rating Scale (DRS) (OR = -3.04; 95% CI, -5.88 to -0.21). In patients with intracranial pressure (ICP) monitoring within 24 hours of admission, dexmedetomidine was associated with higher 6-month GOS-E score (OR 2.17; 95% CI, 1.24–3.80), lower DRS score (adjusted mean difference, –5.81; 95% CI, –9.38 to 2.25), and reduced length of hospital stay ( HR = 1.50; 95% CI, 1.02–2.20).
Investigators concluded that early dexmedetomidine exposure was not associated with improved 6-month functional outcomes in the entire population, although clinical benefit in patients was observed with indications for ICP monitoring.
