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European Journal of Trauma and Emergency Surgery

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22-11-2021 | Laparotomy | Original Article

Dexmedetomidine and paralytic exposure after damage control laparotomy: risk factors for delirium? Results from the EAST SLEEP-TIME multicenter trial

Authors: Cassandra Krause, Eugenia Kwon, Xian Luo-Owen, Kaitlin McArthur, Meghan Cochran-Yu, Lourdes Swentek, Sigrid Burruss, David Turay, Areg Grigorian, Jeffry Nahmias, Ahsan Butt, Adam Gutierrez, Aimee LaRiccia, Michelle Kincaid, Michele N. Fiorentino, Nina Glass, Samantha Toscano, Eric Ley, Sarah R. Lombardo, Oscar D. Guillamondegui, James M. Bardes, Connie DeLa’O, Salina M. Wydo, Kyle Leneweaver, Nicholas T. Duletzke, Jade Nunez, Simon Moradian, Joseph Posluszny, Leon Naar, Haytham Kaafarani, Heidi Kemmer, Mark J. Lieser, Alexa Dorricott, Grace Chang, Zoltan Nemeth, Kaushik Mukherjee

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2022

Abstract

Purpose

To evaluate factors associated with ICU delirium in patients who underwent damage control laparotomy (DCL), with the hypothesis that benzodiazepines and paralytic infusions would be associated with increased delirium risk. We also sought to evaluate the differences in sedation practices between trauma (T) and non-trauma (NT) patients.

Methods

We reviewed retrospective data from 15 centers in the EAST SLEEP-TIME registry admitted from January 1, 2017 to December 31, 2018. We included all adults undergoing DCL, regardless of diagnosis, who had completed daily Richmond Agitation Sedation Score (RASS) and Confusion Assessment Method-ICU (CAM-ICU). We excluded patients younger than 18 years, pregnant women, prisoners and patients who died before the first re-laparotomy. Data collected included age, number of re-laparotomies after DCL, duration of paralytic infusion, duration and type of sedative and opioid infusions as well as daily CAM-ICU and RASS scores to analyze risk factors associated with the proportion of delirium-free/coma-free ICU days during the first 30 days (DF/CF-ICU-30) using multivariate linear regression.

Results

A 353 patient subset (73.2% trauma) from the overall 567-patient cohort had complete daily RASS and CAM-ICU data. NT patients were older (58.9 ± 16.0 years vs 40.5 ± 17.0 years [p < 0.001]). Mean DF/CF-ICU-30 days was 73.7 ± 96.4% for the NT and 51.3 ± 38.7% in the T patients (p = 0.030). More T patients were exposed to Midazolam, 41.3% vs 20.3% (p = 0.002). More T patients were exposed to Propofol, 91.0% vs 71.9% (p < 0.001) with longer infusion times in T compared to NT (71.2 ± 85.9 vs 48.9 ± 69.8 h [p = 0.017]). Paralytic infusions were also used more in T compared to NT, 34.8% vs 18.2% (p < 0.001). Using linear regression, dexmedetomidine infusion and paralytic infusions were associated with decreases in DF/CF-ICU-30, (− 2.78 (95%CI [− 5.54, − 0.024], p = 0.040) and (− 7.08 ([− 13.0, − 1.10], p = 0.020) respectively.

Conclusions

Although the relationship between paralytic use and delirium is well-established, the observation that dexmedetomidine exposure is independently associated with increased delirium and coma is novel and bears further study.

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Title: Dexmedetomidine and paralytic exposure after damage control laparotomy: risk factors for delirium? Results from the EAST SLEEP-TIME multicenter trial
Authors: Cassandra Krause
Eugenia Kwon
Xian Luo-Owen
Kaitlin McArthur
Meghan Cochran-Yu
Lourdes Swentek
Sigrid Burruss
David Turay
Areg Grigorian
Jeffry Nahmias
Ahsan Butt
Adam Gutierrez
Aimee LaRiccia
Michelle Kincaid
Michele N. Fiorentino
Nina Glass
Samantha Toscano
Eric Ley
Sarah R. Lombardo
Oscar D. Guillamondegui
James M. Bardes
Connie DeLa’O
Salina M. Wydo
Kyle Leneweaver
Nicholas T. Duletzke
Jade Nunez
Simon Moradian
Joseph Posluszny
Leon Naar
Haytham Kaafarani
Heidi Kemmer
Mark J. Lieser
Alexa Dorricott
Grace Chang
Zoltan Nemeth
Kaushik Mukherjee
Publication date: 22-11-2021
Publisher: Springer Berlin Heidelberg
Keywords: Laparotomy
Laparotomy
Benzodiazepine
Propofol
Published in: European Journal of Trauma and Emergency Surgery / Issue 3/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01813-x

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Springer Medicine

Dexmedetomidine and paralytic exposure after damage control laparotomy: risk factors for delirium? Results from the EAST SLEEP-TIME multicenter trial

Abstract

Purpose

Methods

Results

Conclusions

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Abstract

Purpose

Methods

Results

Conclusions

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