Precedex for DT's

We've recently started using Precedex for DT's, a patient was requiring 10mg valium q 30 minutes for an extended period of time and there was concern that we were just going to transition the patient into delirium from the DT's (due to a high benzo load), so the patient was swithched to precedex.

Our soft limit is 0.7mcg and our hard limit is 1.4mcg for general precedex use, although I've heard rumors that other facilities may use a limit closer to 2.5 for DT's patients (since the most common concern is bradycardia and hypotension with precedex, which is rarely a problem with patients in severe DT's).

Does anybody else here use precedex for DT's? What's your range? Do you still give benzos as well?
this would be a good topic for REAL investigation from authoritative sources. If you do, please share.

Quote from classicdamethis would be a good topic for REAL investigation from authoritative sources. If you do, please share.

I'd be interested, too. I have read that case study and would like to see more meta analysis on the topic. I recently had a DT pt that I would have liked to try on Precedex. Like you said, dosing is the question, we're still pretty conservative with the dosing where I work and would not be trying higher doses, which may be better than the alternatives... in this case we were infusing propofol at about 70 mcg. Can we say PRIS?Likewise, I'm eagerly waiting the publish of ongoing studies validating Precedex use for over 24 hours. That's holding us back, too.

Quote from XingtheBBBI'd be interested, too. I have read that case study and would like to see more meta analysis on the topic. I recently had a DT pt that I would have liked to try on Precedex. Like you said, dosing is the question, we're still pretty conservative with the dosing where I work and would not be trying higher doses, which may be better than the alternatives... in this case we were infusing propofol at about 70 mcg. Can we say PRIS?Likewise, I'm eagerly waiting the publish of ongoing studies validating Precedex use for over 24 hours. That's holding us back, too.

My unit commonly uses precedex for patients in DTs. We have found that especially for our alcoholics who get intubated for say a GI bleed that the precedex generally helps us to get them down without just burying them in benzos or propofol. The only problem is that sometimes our docs feel that the precedex blunts their physiological symptoms (tachycardia and hypertension) that they use to help dose their ativan/valium (our unit does not use the CIWA protocol). Otherwise we use it to bridge the people to extubation, start the precedex and wean their sedation until they can follow commands and get extubated. We also will start people on precedex who are un-intubated, however, we don't go very high on the doses 0.6-0.8mcg/kg/hr, if they are intubated we go up to 1.6-1.8mcg/kg/hr.