Clinical characteristics and outcomes using dexmedetomidine in nonintubated patients: A poison center observational study.

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PURPOSE: Dexmedetomidine is a central alpha-2 agonist commonly used on intubated patients. It is increasingly being used off-label in non-intubated agitated patients. We sought to determine the overall clinical course, adverse effects, and need for subsequent mechanical ventilation in toxicology patients after treatment with dexmedetomidine.

METHODS: This was a retrospective cohort study conducted by chart review of electronic records from the Virginia Poison Control Center from January 1, 2019 to February 4, 2022. Inclusion criteria consisted of all poison center cases where dexmedetomidine was used. The primary outcome was the presence or absence of clinical improvement following dexmedetomidine use. Secondary outcomes included adverse effects, subsequent intubation, or death.

RESULTS: During this study period, there were 220 cases in which dexmedetomidine was used to treat agitation. After exclusions, 70 cases were analyzed. The categories included antimuscarinic (n= 19), polysubstance (n= 16), sedative withdrawal (n = 10), unknown agitation (n= 7), sympathomimetic (n =5), baclofen withdrawal (n= 3), unknown ingestion (n = 3), sedative/hypnotic (n= 2), antipsychotic (n = 2), hallucinogenic (n= 2), and opioid withdrawal (n= 1). Clinical improvement occurred in 62 of 70 patients (89%). There were no deaths. A total of four patients were intubated after starting dexmedetomidine, two for refractory agitation and two for hypoxia after aspiration.

CONCLUSION: Global clinical improvement was observed in the agitated toxicology patients administered dexmedetomidine. There was one case of intubation secondary to oversedation. Dexmedetomidine could be a useful adjunctive treatment for agitated toxicologic patients but should be studied further before routinely used.