(1567) Successful Transitions From High-Dose Propofol to Dexmedetomidine

Introduction: In our institution, prescribers commonly transition patients from propofol to dexmedetomidine, prior to extubation. The purpose of this research is to assess if successful transitions to dexmedetomidine are affected by the dose of propofol.

Methods: For the period 6/1/2019 to 6/30/2022, electronic medical records were used to identify mechanically ventilated trauma intensive care unit patients over 18 years of age and receiving propofol sedation for at least 24 hours prior to transition attempt to dexmedetomidine. The primary objective of the study was to assess successful transitions from propofol to dexmedetomidine, defined as continuation of dexmedetomidine for at least 48 hours without reinstitution of propofol or otherwise extubated on dexmedetomidine. Successful transitions were compared between the high-dose and low-dose propofol patient cohorts using chi square analysis. High dose propofol was defined as >30 mCg/kg/min.

Results: A total of 106 patients, 76 in the high dose cohort and 33 in the low dose cohort, were included in the study. The median ICU length of stay was 16.5 days and 12.0 days [respectively]. The highest dose of propofol within 6 hours of dexmedetomidine infusion was 17.5 mCg/kg/min in the low dose cohort and 50.6 mCg/kg/min in the high dose cohort. The highest dose of dexmedetomidine within 48 hours off propofol was 0.63 mCg/kg/hour in the low dose cohort and 1.05 mCg/kg/hour in the high dose cohort, p< 0.001. In the low dose cohort, 70% of patients were successfully transitioned to dexmedetomidine, compared to 61.8% of patients in the high dose cohort, p=0.430. The median RASS post-transition in both cohorts was 1.

Conclusions: Successful transitions to dexmedetomidine were not statistically affected by the dose of propofol. Although not statistically significant, patients in the high dose cohort had more occurrences of RASS scores greater than 2 post transition. Further research is required to assess the impact of confounding variables.