Association of Early Dexmedetomidine Utilization With Clinical Outcomes After Moderate-Severe Traumatic Brain Injury: A Retrospective Cohort Study

作者：Sunny Yang Liu, Margot Kelly-Hedrick, Jordan M. Komisarow, Jordan K. Hatfield, Tetsu Ohnuma, Miriam M. Treggiari, Katharine Colton, Evangeline Arulraja, Monica Shanta Vavilala, Daniel T. Laskowitz, Joseph P. Mathew, Adrian F. Hernandez, Michael Lucas James, Karthik Raghunathan, Vijay Krishnamoorthy · 发表于：Anesthesia & Analgesia · 年份：2024 · DOI：10.1213/ane.0000000000006869 · 被引用次数：13 · 研究领域：Traumatic Brain Injury and Neurovascular Disturbances、Intensive Care Unit Cognitive Disorders、Anesthesia and Sedative Agents

BACKGROUND: Traumatic brain injury (TBI) is an expensive and common public health problem. Management of TBI oftentimes includes sedation to facilitate mechanical ventilation (MV) for airway protection. Dexmedetomidine has emerged as a potential candidate for improved patient outcomes when used for early sedation after TBI due to its potential modulation of autonomic dysfunction. We examined early sedation patterns, as well as the association of dexmedetomidine exposure with clinical and functional outcomes among mechanically ventilated patients with moderate-severe TBI (msTBI) in the United States. METHODS: We conducted a retrospective cohort study using data from the Premier dataset and identified a cohort of critically ill adult patients with msTBI who required MV from January 2016 to June 2020. msTBI was defined by head-neck abbreviated injury scale (AIS) values of 3 (serious), 4 (severe), and 5 (critical). We described early continuous sedative utilization patterns. Using propensity-matched models, we examined the association of early dexmedetomidine exposure (within 2 days of intensive care unit [ICU] admission) with the primary outcome of hospital mortality and the following secondary outcomes: hospital length of stay (LOS), days on MV, vasopressor use after the first 2 days of admission, hemodialysis (HD) after the first 2 days of admission, hospital costs, and discharge disposition. All medications, treatments, and procedures were identified using date-stamped hospit...