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Dexmedetomidine을 투여한 내과중환자실 환자의 심혈관계 부작용 발생률과 위험인자 분석

Incidence and Risk Factors for Dexmedetomidine-Associated Cardiovascular Adverse Effects in Intensive Care Unit Patients

병원약사회지 2020년 37권 3호 p.279 ~ 291
안혜림, 김지원, 안서현, 박애령, 황보신이,
소속 상세정보
안혜림 ( Ahn Hye-Lim ) - Catholic University Seoul St. Mary’s Hospital Department of Pharmacy
김지원 ( Kim Ji-Won ) - Catholic University Seoul St. Mary’s Hospital Department of Pharmacy
안서현 ( Ahn Seo-Hyun ) - Catholic University Seoul St. Mary’s Hospital Department of Pharmacy
박애령 ( Park Ae-Ryoung ) - Catholic University Seoul St. Mary’s Hospital Department of Pharmacy
황보신이 ( Hwangbo Shin-Yi ) - Catholic University Seoul St. Mary’s Hospital Department of Pharmacy

Abstract


Background : Dexmedetomidine is a selective α2 agonist with sedative, analgesic, and sympatholytic properties. Dexmedetomidine has cardiovascular risks such as hypotension and bradycardia. For this reason, the U.S. Food and Drug Administration (FDA) recommends the short-term use of dexmedetomidine less than 24 hours. Therefore, this study was aimed at analyzing the current status and risk factors of the cardiovascular side effects of dexmedetomidine.

Methods : A retrospective chart review of all adult critically ill patients in the medical intensive care units who received dexmedetomidine from January 2016 to May 2017 was performed. The incidence, risk factors and prognosis of the cardiovascular adverse effects were analyzed.

Results : The total number of patients was 135, and the mean hours of dexmedetomidine administration was 165 hours. A total of 102 patients (75.6%) developed cardiovascular side effects. Among them, hypotension occurred in 99 patients (73.3%), of which 53 patients (53.5%) developed hypotension within 24 hours. Bradycardia occurred in eight patients (5.9%), of which two patients (25.0%) developed bradycardia within 24 hours. Multivariate analysis of the risk factors for hypotension showed an association between hypotension and low baseline mean arterial pressure (MAP)(p=0.028), patients with acute respiratory distress syndrome (ARDS)(p=0.030) and those given norepinephrine (p=0.017). The incidence of hypotension was lower in patients with underlying hypertension (p=0.030). Univariate analysis of the risk factors for bradycardia showed that the incidence of bradycardia was higher in patients with lower baseline heart rates (p=0.033), higher body weight (p=0.008), and those undergoing hemodialysis (p=0.009). Also, there were no significant differences in the days of mechanical ventilation, the number of hospital days, and the mortality rate in patients with hypotension or bradycardia.

Conclusion : Dexmedetomidine was associated with a higher incidence of cardiovascular side effects. Specifically, patients who were diagnosed with lower MAP, ARDS, or in combination with norepinephrine use were more likely to develop hypotension. Therefore, it is necessary to closely monitor cardiovascular adverse effects in patients with these risk factors.

키워드

Dexmedetomidine; Hypotension; Bradycardia; Cardiovascular adverse events; Critically ill patients

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