(143) Safety of Dexmedetomidine Use in Right Ventricular Dysfunction

Introduction: Dexmedetomidine is recommended as a preferred option for sedation in critically ill, mechanically ventilated patients. Hemodynamic adverse events in patients receiving dexmedetomidine has been described in the literature, however, safety data in patients with right ventricular (RV) dysfunction is lacking. The purpose of this study was to determine the prevalence of adverse events in patients with RV dysfunction treated with dexmedetomidine.

Methods: Single-center retrospective chart review of adult patients admitted to any ICU at the University of Michigan from January 2017 to January 2022 with RV dysfunction who received dexmedetomidine. The primary outcome was the composite of adverse events, including bradycardia, hypotension, increasing vasopressor/inotrope requirements, and asystole within 24 hours after dexmedetomidine initiation. Secondary outcomes included individual components of the primary outcome and a comparison of RV dysfunction severity with adverse event rates. For the primary outcome, descriptive statistics were employed to describe the rate of adverse events. For the secondary outcomes, Chi-square and student’s t-test were used, as appropriate

Results: A total of 245 patients met study inclusion criteria. There were 204 adverse events in 153 patients. Hypotension was the most common adverse event, making up 61.3% of adverse events reported. Increased vasopressor requirements occurred in 65 patients (32.0%). Bradycardia occurred in 13 patients (6.4%). One patient required an increased inotrope dose. There was no difference in adverse event rates among patients with mild, moderate, or severe RV dysfunction. Patients with both left ventricular and RV dysfunction were not associated with an increased risk of an adverse event compared to those with RV dysfunction (29.4% vs. 25.0%, P=0.45).

Conclusions: Patients with RV dysfunction experienced a high rate of adverse events with dexmedetomidine use. Findings from this study may assist in tailoring sedation regimens for critically ill patients with RV dysfunction. Future research is needed to explore optimal sedative agents for patients with RV dysfunction admitted to an ICU.