Intravenous dantrolene in hypermetabolic syndromes: a survey of the U.S. Veterans Health Administration database View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2022-09-19

AUTHORS

Stanley N. Caroff, Christopher B. Roberts, Henry Rosenberg, Joseph R. Tobin, Stacey Watt, Darlene Mashman, Sheila Riazi, Rosalind M. Berkowitz

ABSTRACT

BackgroundIntravenous dantrolene is often prescribed for hypermetabolic syndromes other than the approved indication of malignant hyperthermia (MH). To clarify the extent of and indications for dantrolene use in conditions other than MH, we sought to document current practices in the frequency, diagnoses, clinical characteristics and outcomes associated with dantrolene treatment in critical care settings.MethodsInpatients receiving intravenous dantrolene from October 1, 2004 to September 30, 2014 were identified retrospectively in the U.S. Veterans Health Administration national database. Extracted data included; diagnoses of hypermetabolic syndromes; triggering drugs; dantrolene dosages; demographics; vital signs; laboratory values; in-hospital mortality; complications; and lengths of stay. Frequency and mortality of patients who did not receive dantrolene were obtained in selected diagnoses for exploratory comparisons.ResultsDantrolene was administered to 304 inpatients. The most frequent diagnoses associated with dantrolene treatment were neuroleptic malignant syndrome (NMS; N = 108, 35.53%) and sepsis (N = 47, 15.46%), with MH accounting for only 13 (4.28%) cases. Over half the patients had psychiatric comorbidities and received psychotropic drugs before dantrolene treatment. Common clinical findings in patients receiving dantrolene included elevated temperature (mean ± SD; 38.7 ± 1.3 °C), pulse (116.33 ± 22.80/bpm), respirations (27.75 ± 9.58/min), creatine kinase levels (2,859.37 ± 6,646.88 IU/L) and low pO2 (74.93 ± 40.16 mmHg). Respiratory, renal or cardiac failure were common complications. Mortality rates in-hospital were 24.01% overall, 7.69% in MH, 20.37% in NMS and 42.55% in sepsis, compared with mortality rates in larger and possibly less severe groups of unmatched patients with MH (5.26%), NMS (6.66%), or sepsis (41.91%) who did not receive dantrolene.ConclusionsIn over 95% of cases, dantrolene administration was associated with diagnoses other than MH in critically-ill patients with hypermetabolic symptoms and medical and psychiatric comorbidities. Exploratory survey data suggested that the efficacy and safety of dantrolene in preventing mortality in hypermetabolic syndromes other than MH remain uncertain. However, randomized and controlled studies using standardized criteria between groups matched for severity are essential to guide practice in using dantrolene. More... »

PAGES

298

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12871-022-01841-z

DOI

http://dx.doi.org/10.1186/s12871-022-01841-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1151118761

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/36123618


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80 hyperthermia
81 ill patients
82 indications
83 inpatients
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85 kinase levels
86 laboratory values
87 length
88 length of stay
89 levels
90 low PO2
91 malignant hyperthermia
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93 mortality
94 mortality of patients
95 mortality rate
96 national database
97 neuroleptic malignant syndrome
98 outcomes
99 patients
100 practice
101 psychiatric comorbidity
102 psychotropic drugs
103 pulses
104 rate
105 respiration
106 safety
107 sepsis
108 setting
109 severe group
110 severity
111 signs
112 standardized criteria
113 stay
114 study
115 survey
116 survey data
117 symptoms
118 syndrome
119 temperature
120 treatment
121 unmatched patients
122 use
123 values
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