PSHP 2026 Residency Conference

PURPOSE: This study evaluates the incidence of bradycardia following dexmedetomidine initiation in critically ill patients and identifies clinical predictors and dosing patterns to inform monitoring and optimize sedation practices.
METHODS: This retrospective chart review included critically ill adult patients who received a dexmedetomidine infusion for greater than 2 hours admitted to a non-cardiac intensive care unit (ICU) from November 1st, 2024 to November 1st, 2025. The primary outcome was the incidence of bradycardia defined as less than 60 beats per minute (bpm) following dexmedetomidine initiation. Secondary outcomes included incidence of severe bradycardia (less than 40 bpm or requiring clinical action), incidence of hypotension, time to first bradycardic event, dose and duration of infusion, liver function on ICU admission, body mass index (BMI) at time of infusion initiation, and concomitant use of vasoactive or rate-controlling medications. Descriptive statistics were used to summarize primary and secondary outcomes, and a binary logistic regression was performed as an exploratory analysis to identify predictors of bradycardia.
RESULTS: Seventy patients were included, with bradycardia occurring in 25 patients (35.7%). Severe bradycardia occurred in 2 patients (2.9%). Median time to first bradycardic event was 6.33 hours [2.93, 10.45]. Median infusion duration was 28.1 hours [14.6, 72], and mean infusion rate was 0.99 ± 0.48 mcg/kg/hr. Hypotension occurred in 41 patients (58.6%), and vasopressor therapy was continued or initiated in a subset of patients during infusion. In a binary logistic regression, higher heart rate on hospital admission was associated with increased odds of bradycardia [p=0.013, (OR 1.046, 95% CI 1.010-1.084)], while higher heart rate at dexmedetomidine initiation was associated with decreased odds of bradycardia [p=0.004 (OR 0.936, 95% CI 0.896-0.979)].
CONCLUSION: Bradycardia occurred in over one-third of critically ill patients receiving dexmedetomidine. Baseline heart rate predicted bradycardia risk, with effects varying based on when it was measured, as higher heart rate on hospital admission increased risk while higher heart rate at dexmedetomidine initiation was associated with lower risk. These findings highlight the need for patient-specific assessment and close monitoring during therapy.
IRB Approval: iRISID-2026-0188