2026 Eastern States Conference

Title: Adverse reactions by body mass index in intensive care unit patients receiving dexmedetomidineAuthors: Dellani Fix, PharmD; Brian Hodges, PharmD, BCCCP, BCNSP; Brian Burton, MS
Learning Objective: At the conclusion of this presentation, the participant will be able to describe the relationship between body mass index and hemodynamic adverse reactions in intensive care unit patients receiving dexmedetomidine. Background/Objective: To compare rates of hypotension and bradycardia in obese versus non-obese intensive care unit patients receiving dexmedetomidine infusions.Methods: This retrospective, single-center cohort study evaluated adult intensive care unit patients who received dexmedetomidine for at least 24 hours between January 1, 2022,and January 1, 2023, and were hemodynamically stable at initiation. Exclusion criteria included age less than 18 years, transfer on dexmedetomidine, cirrhosis, alcohol use disorder, mechanical circulatory support, pacemaker, or procedural sedation only. Patients were stratified by body mass index greater than 30 kilograms per meter squared. Primary outcomes were incidence of hypotension (systolic blood pressure less than 90 millimeters of mercury) and bradycardia (heart rate less than 55 beats per minute). Secondary outcomes included intensive care unit length of stay and vasopressor initiation within one hour. Outcomes were compared between groups. 
Results: Of 639 patients screened, 147 met inclusion criteria, including 82 obese and 65 non-obese patients. Maximum dexmedetomidine dose was similar between groups. Bradycardia occurred in 21.9% of non-obese patients and 18.5% of obese patients (p=0.60). Hypotension occurred in 62.2% of non-obese patients and 49.2% of obese patients (p=0.12). No significant differences were observed in secondary outcomes.
Conclusions: Obesity was not associated with increased hemodynamic adverse reactions or differences in clinical outcomes in patients receiving dexmedetomidine infusions. These findings support the use of total body weight-based dosing in patients with obesity.