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930: COMPARISON OF VANCOMYCIN TROUGH ATTAINMENT IN OBESE SEPTIC PATIENTS VERSUS NON-OBESE SEPTIC PATIENTS

Learning Objectives: The specific effects of non-benzodiazepines on development of clinically significant hypotensive and bradycardic events in patients with sepsis and more specifically septic shock remain undetermined due to ambiguous definitions and heterogeneous populations in previous studies. The purpose of this study was to compare the development of clinically significant hypotension and bradycardia in adult patients with septic shock receiving either propofol or dexmedetomidine. Methods: A retrospective cohort study of adults with septic shock admitted to an ICU at an academic medical center between July 2013 and July 2017. The primary outcome was development of a clinically significant hemodynamic event, defined as either clinically significant hypotension (an increase in vasopressor dosage by at least 20%, addition of another vasopressor, and/or decrease from baseline in SBP by 30 mm Hg or MAP by 10 mmHg) or clinically significant bradycardia (a decrease from baseline in HR by 30 beats/min or HR less than 50 beats/min). Baseline characteristics were compared between propofol and dexmedetomidine groups. Primary and secondary outcomes were analyzed via student t-test for continuous data and Pearson’s chi-square or Fischer’s exact test, as appropriate, for categorical data. All analyses were performed using Spss.v23. Results: Patients in the propofol and dexmedetomidine groups developed a clinically significant hemodynamic event at similar frequencies (31.4 vs 29.7%, p=0.99). Most patients in both groups (70 vs 90%) received an escalating sedative dose, and almost half (42.9%) in the dexmedetomidine group had the sedative dosage increased more frequently than every 30 minutes. Patients in both groups had similar ICU (24.1 vs 24.3 days, p=0.98) and hospital (37.9 vs 29.7 days, p=0.29) lengths of stay. Mortality at 28 days was similar between groups (40 vs 59.5%, p=0.16). There was no difference in time to hemodynamic event between groups. Most patients developed hypotension within 48 hours of sedative initiation. Conclusions:: Patients with septic shock receiving propofol or dexmedetomidine experienced similar rates of clinically significant hemodynamic events. Most patients did not experience an event, and those who did most frequently did so in the first few hours of therapy.