(144) The Effect of Dexmedetomidine on the Duration of Mechanical Ventilation Following CV Surgery

Introduction: The Society of Thoracic Surgeons (STS) recommends early extubation, defined as ≤ 6 hours, following cardiovascular surgery. It remains undetermined if post-procedural sedation strategies influence the duration of mechanical ventilation. The 2018 Society of Critical Care Medicine guidelines recommend propofol or dexmedetomidine for sedation in mechanically ventilated patients, making no specific recommendations for cardiac surgery patients. The purpose of this study was to evaluate the effects of dexmedetomidine post-cardiovascular surgery on the duration of mechanical ventilation.

Methods: A single-center, retrospective, cohort study was conducted on adult patients admitted to Prisma Health—Upstate between February 2022 and August 2022 for cardiovascular surgery. Sedation with dexmedetomidine was compared to propofol assessing the duration of mechanical ventilation as the primary outcome. Secondary outcomes included incidence of delirium, hospital length of stay, intensive care unit length of stay, incidence of atrial fibrillation, and 30-day mortality.

Results: Two hundred fifty-seven patients were screened, and 183 patients met inclusion criteria with 165 in the propofol group compared to 18 in the dexmedetomidine group. Baseline demographics were similar overall, with surgery duration being the only statistically significant difference. To control for confounding, opioid and benzodiazepine use was collected, and no differences were found. The duration of mechanical ventilation was 6.0 hours in the propofol group versus 5.3 in the dexmedetomidine group (p=0.391). There were no significant differences in incidence of delirium, hospital length of stay, intensive care unit length of stay, incidence of atrial fibrillation, or 30-day mortality.

Conclusions: Dexmedetomidine did not demonstrate any statistically significant benefits when used for post-operative sedation following cardiovascular surgery compared to propofol. Further studies are warranted to determine the preferred sedative following cardiovascular surgery.