Safety of Dexmedetomidine Use in Adult ICU Patients With Right Ventricular Dysfunction

Background Dexmedetomidine is commonly used in the intensive care unit (ICU) and is associated with hemodynamic adverse events, including hypotension and bradycardia. Use of dexmedetomidine has not been described in critically ill patients with right ventricular (RV) dysfunction and may be particularly relevant given the tenuous hemodynamics in this patient population. Objective Determine the prevalence of adverse events in adult ICU patients with RV dysfunction receiving dexmedetomidine. Methods This single-center, retrospective cohort study included adult ICU patients with RV dysfunction measured by echocardiogram who received dexmedetomidine between January 2017 and December 2022. The primary outcome was a composite of adverse events after dexmedetomidine initiation including bradycardia, hypotension, increasing vasopressor/inotrope requirements, and asystole. Secondary outcomes included individual components of the primary outcome and a comparison of adverse events based on RV dysfunction severity. Results A total of 245 patients met study inclusion criteria. A total of 178 adverse events occurred in 153 patients (62.4%). The most common adverse event was hypotension occurring in 129 patients (72.5%). Increased vasopressor requirements occurred in 35 patients (19.7%), and mean change in norepinephrine equivalents from baseline was 0.06 µg/kg/min. Adverse event rates did not differ among patients with mild, moderate, or severe RV dysfunction. Conclusion Adult ICU patients with RV dysfunction receiving dexmedetomidine experienced high rates of hypotension and increased vasopressor requirements. Findings from this study may assist in tailoring sedation regimens for critically ill patients with RV dysfunction. Future research is needed to explore optimal sedative agents in this patient population.