The Utilization of Dexmedetomidine for Sedation in Air and Ground Critical Care Transport

Dexmedetomidine is a commonly used sedative agent for both intubated and nonintubated patients. Despite its frequent in-hospital use, the description of its use in the critical care transport (CCT) environment is limited.

This study aimed to describe the use of dexmedetomidine during CCT.

This was a multicenter, retrospective review of patients transported by 2 hospital-based CCT agencies from January 4, 2024, to January 3, 2026. Transport modality (air or ground), patient information (age, sex, airway status, mode of ventilation, and Richmond agitation sedation scale [RASS]), clinical impression, and the use of additional sedatives were compiled. Descriptive statistics were then performed for each category.

A total of 185 patients were administered dexmedetomidine. The median age was 40 years [interquartile range (IQR), 5-62], and 64% were male. Two-thirds (122; 66%) were mechanically ventilated, 34 (18%) received noninvasive ventilation, 13 (7%) received only supplemental oxygen, and 14 (8%) were on ambient air. Pediatrics were more likely to have patent airways (63% vs. 20%; P < .001). The median starting infusion rate was 0.6 mcg/kg/h [IQR, 0.3-0.9] and was titrated in 78% of cases. Additional sedative medications were administered to 59% of patients. No noninvasive ventilation patients required intubation. The infusion was initiated by the transport team in 39 cases (21%) with a median change in RASS of -2 [IQR, -3 to 0].

Dexmedetomidine seems to be an effective sedative in the CCT environment to facilitate both invasive and noninvasive ventilation in adult and pediatric patients. Further prospective studies are warranted to compare its safety and effectiveness with other commonly used sedation strategies.