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223: EFFECT OF OBESITY ON DEXMEDETOMIDINE-ASSOCIATED HYPOTENSION IN CARDIOVASCULAR CRITICAL CARE PATIENTS

Learning Objectives: Dexmedetomidine (DEX) is widely used in cardiac surgery patients for sedation as it has been associated with a decrease in duration of mechanical ventilation and reduction in intensive care unit (ICU) and hospital length of stay (LOS); however, it has been shown to lead to higher rates of hypotension and bradycardia when compared to other sedative agents. Additionally, recent research has shown that clearance of DEX may be impaired in obese patients. Given this, we aimed to determine if obese patients experienced higher rates of hypotension with DEX compared to non-obese patients. Methods: A retrospective cohort study of patients with a primary cardiac diagnosis who received dexmedetomidine in the cardiovascular ICU between September 2013 and August 2016 was completed. The primary objective was to determine the incidence of hypotension (MAP < 60 mmHg) in those who were obese (body mass index [BMI] ≥ 30) compared to those who were non-obese (BMI < 30). Secondary outcomes included incidence of bradycardia (HR < 50 bpm), duration of mechanical ventilation, as well as ICU and hospital LOS. Results: Of the 272 patients included in the analysis, the majority of patients were male (63.8%) and Caucasian (60.3%) with a median age of 62 years. The median BMI of the entire sample was 30 and 136 (50%) were obese. The median initial dose was no different between groups, with the median maximum dose being 0.7 mcg/kg/hr in both groups. Non-obese patients received treatment with DEX for longer than their obese counterparts (20 hours 37 minutes vs. 17 hour 5 minutes; p=0.03). Overall, there were no differences in the rate of hypotension (39% vs. 41.9%; p=0.62) or bradycardia (5.1% vs. 3.7%; p=0.56) between the non-obese and obese groups. Non-obese patients experienced longer median duration of mechanical ventilation (1.3 vs. 1 days; p=0.03) and ICU LOS (4.5 vs. 3.1 days; p=0.04) but no difference in median hospital LOS (11 vs. 10.3 days; p=0.43). Conclusions: We observed no difference in rates of DEX-associated hypotension among obese cardiovascular ICU patients. Nonobese patients had longer durations of mechanical ventilation and were on DEX infusions longer than obese patients. CCMCritical Care MedicineCrit Care Med0090-3493Lippincott Williams & WilkinsHagerstown, MD CCM