TY - JOUR
T1 - Association of Early Dexmedetomidine Utilization With Clinical and Functional Outcomes Following Moderate-Severe Traumatic Brain Injury
T2 - A Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study
AU - The Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) Investigators
AU - Liu, Sunny Yang
AU - Kelly-Hedrick, Margot
AU - Temkin, Nancy
AU - Barber, Jason
AU - Komisarow, Jordan
AU - Hatfield, Jordan
AU - Ohnuma, Tetsu
AU - Manley, Geoffrey
AU - Treggiari, Miriam M.
AU - Colton, Katharine
AU - Vavilala, Monica S.
AU - Grandhi, Ramesh
AU - Laskowitz, Daniel T.
AU - Mathew, Joseph P.
AU - Hernandez, Adrian
AU - James, Michael L.
AU - Raghunathan, Karthik
AU - Goldstein, Ben
AU - Markowitz, Amy
AU - Krishnamoorthy, Vijay
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/4
Y1 - 2024/4
N2 - OBJECTIVE: To examine early sedation patterns, as well as the association of dexmedetomidine exposure, with clinical and functional outcomes among mechanically ventilated patients with moderate-severe traumatic brain injury (msTBI). DESIGN: Retrospective cohort study with prospectively collected data. SETTING: Eighteen Level-1 Trauma Centers, United States. PATIENTS: Adult (age > 17) patients with msTBI (as defined by Glasgow Coma Scale < 13) who required mechanical ventilation from the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using propensity-weighted models, we examined the association of early dexmedetomidine exposure (within the first 5 d of ICU admission) with the primary outcome of 6-month Glasgow Outcomes Scale Extended (GOS-E) and the following secondary outcomes: length of hospital stay, hospital mortality, 6-month Disability Rating Scale (DRS), and 6-month mortality. The study population included 352 subjects who required mechanical ventilation within 24 hours of admission. The initial sedative medication was propofol for 240 patients (68%), midazolam for 59 patients (17%), ketamine for 6 patients (2%), dexmedetomidine for 3 patients (1%), and 43 patients (12%) never received continuous sedation. Early dexmedetomidine was administered in 77 of the patients (22%), usually as a second-line agent. Compared with unexposed patients, early dexmedetomidine exposure was not associated with better 6-month GOS-E (weighted odds ratio [OR] = 1.48; 95% CI, 0.98–2.25). Early dexmedetomidine exposure was associated with lower DRS (weighted OR = –3.04; 95% CI, –5.88 to –0.21). In patients requiring ICP monitoring within the first 24 hours of admission, early dexmedetomidine exposure was associated with higher 6-month GOS-E score (OR 2.17; 95% CI, 1.24–3.80), lower DRS score (adjusted mean difference, –5.81; 95% CI, –9.38 to 2.25), and reduced length of hospital stay (hazard ratio = 1.50; 95% CI, 1.02–2.20). CONCLUSION: Variation exists in early sedation choice among mechanically ventilated patients with msTBI. Early dexmedetomidine exposure was not associated with improved 6-month functional outcomes in the entire population, although may have clinical benefit in patients with indications for ICP monitoring.
AB - OBJECTIVE: To examine early sedation patterns, as well as the association of dexmedetomidine exposure, with clinical and functional outcomes among mechanically ventilated patients with moderate-severe traumatic brain injury (msTBI). DESIGN: Retrospective cohort study with prospectively collected data. SETTING: Eighteen Level-1 Trauma Centers, United States. PATIENTS: Adult (age > 17) patients with msTBI (as defined by Glasgow Coma Scale < 13) who required mechanical ventilation from the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using propensity-weighted models, we examined the association of early dexmedetomidine exposure (within the first 5 d of ICU admission) with the primary outcome of 6-month Glasgow Outcomes Scale Extended (GOS-E) and the following secondary outcomes: length of hospital stay, hospital mortality, 6-month Disability Rating Scale (DRS), and 6-month mortality. The study population included 352 subjects who required mechanical ventilation within 24 hours of admission. The initial sedative medication was propofol for 240 patients (68%), midazolam for 59 patients (17%), ketamine for 6 patients (2%), dexmedetomidine for 3 patients (1%), and 43 patients (12%) never received continuous sedation. Early dexmedetomidine was administered in 77 of the patients (22%), usually as a second-line agent. Compared with unexposed patients, early dexmedetomidine exposure was not associated with better 6-month GOS-E (weighted odds ratio [OR] = 1.48; 95% CI, 0.98–2.25). Early dexmedetomidine exposure was associated with lower DRS (weighted OR = –3.04; 95% CI, –5.88 to –0.21). In patients requiring ICP monitoring within the first 24 hours of admission, early dexmedetomidine exposure was associated with higher 6-month GOS-E score (OR 2.17; 95% CI, 1.24–3.80), lower DRS score (adjusted mean difference, –5.81; 95% CI, –9.38 to 2.25), and reduced length of hospital stay (hazard ratio = 1.50; 95% CI, 1.02–2.20). CONCLUSION: Variation exists in early sedation choice among mechanically ventilated patients with msTBI. Early dexmedetomidine exposure was not associated with improved 6-month functional outcomes in the entire population, although may have clinical benefit in patients with indications for ICP monitoring.
KW - mechanical ventilation
KW - sedation
KW - traumatic brain injury
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U2 - 10.1097/CCM.0000000000006106
DO - 10.1097/CCM.0000000000006106
M3 - Article
C2 - 37966330
AN - SCOPUS:85187958567
SN - 0090-3493
VL - 52
SP - 607
EP - 617
JO - Critical care medicine
JF - Critical care medicine
IS - 4
ER -