(939) Impact of Dexmedetomidine Discontinuation on Spontaneous Breathing Trial

Introduction: A spontaneous breathing trial (SBT) is frequently performed on ventilated patients in the intensive care unit (ICU) to minimize the duration of mechanical ventilation. Dexmedetomidine (DEX) is used to combat agitation that is precluding extubation in mechanically ventilated patients. Institutional practices vary regarding the use of DEX during a SBT. The objective of this medication use evaluation was to assess SBT failure rates due to the inappropriate discontinuation of DEX.

Methods: This was a single-center retrospective review at Miami Valley Hospital from April 1st, 2024 to July 2nd, 2024 in patients who were intubated and receiving DEX. The most recent SBT documented post DEX initiation was collected to assess for success or failure. Confounding sedative medication administrations were collected 24 hours before SBT, during SBT, and 24 hours after SBT. Additional data points included ICU length of stay (LOS), duration of mechanical ventilation, SOFA score, RASS before initiation of DEX and the RASS before, during, and after SBT.

Results: Of the 47 patients included, 32 patients received DEX during the SBT (DEX-ON) and 9 patients had DEX discontinued during SBT (DEX-OFF). Baseline characteristics were similar between DEX-ON and DEX-OFF groups with majority of patients male (56% vs 55%), middle aged (58±18 years vs 51±19 years), white (78% vs 55%) with a SOFA score of 6 (6±2 vs 6±1), respectively. The primary outcome of SBT failure was not significantly different (1.24 [1.08-1.41], p>0.99). Secondary outcomes including ICU LOS, duration of mechanical ventilation, and duration of DEX infusion were not significantly different. The most common adjunctive sedative medication used in both groups was midazolam. RASS before initiation of DEX and surrounding SBT were similar between groups.

Conclusions: Inappropriate discontinuation of dexmedetomidine during SBT did not impact SBT failure rates. Despite DEX continuation, patients still required various adjunctive sedative medications. This analysis demonstrated DEX was initiated in a patient population undergoing SBT that was potentially not experiencing agitation precluding extubation indicating DEX may not have shown benefit in this population as has been demonstrated in previous literature.