PSHP 2026 Residency Conference

The purpose of this study is to evaluate the effects of implementation of a new dexmedetomidine clinical practice guideline (CPG) in intermediate and intensive care units to manage α2 withdrawal at Thomas Jefferson University Hospital.
An update was made to the local clinical practice guidelines for the use of dexmedetomidine for α2 withdrawal management including an increase in the maximum allowed infusion rate and changing the titration parameters from RASS to vital signs (heart rate and blood pressure). A SlicerDicer report generated by Epic electronic health record (EHR) identified patients who had a dexmedetomidine continuous infusion order and a consult with the Jefferson Addiction Multidisciplinary Service (JAMS) from 01/01/2026-02/01/2026 for the pre-intervention group and from 3/17/2026-4/17/2026 for the post-intervention group. The primary endpoint was the average length of stay (LOS). Secondary endpoints included, disposition, ICU admission rate, ICU LOS, intubation rate, vital sign abnormalities, adverse side event occurrence, and dexmedetomidine infusion data. Descriptive statistics were used. The study was approved as exempt by the Jefferson IRB.
The baseline characteristics between the pre and post intervention groups were similar.  The primary endpoint of average length of stay was shorter in the post intervention group compared to the pre intervention group (5.2 vs 7.3 days). Results of the secondary endpoints were similar between both groups. The rate of ICU admission was greater in the post intervention group (45.4 vs 41.4%). The average maximum and minimum heart rates were marginally decreased in the post intervention group compared to the pre intervention group (128 vs 124; 63 vs 60 bpm). The duration of dexmedetomidine therapy was shorter in the post intervention group (64 vs 65.9 hours). None of the differences seen in the secondary outcomes were clinically significant.
The updated clinical guideline for dexmedetomidine resulted in a shorter length of stay in the post intervention group versus the pre intervention group.  All other endpoints remained similar between the two groups. Limitations included a small sample size, challenges in implementation, nursing workflow constraints, and an abbreviated data collection period. Further research is warranted to refine this approach to α2 withdrawal management.