登入選單
返回Google圖書搜尋
出版Morressier, 2017
URLhttp://books.google.com.hk/books?id=GLeyzQEACAAJ&hl=&source=gbs_api
註釋Background and Goal of Study: Dexmedetomidine (DX) has three main clinical uses: prolonged sedation in hospitalized patients, procedural sedation and general anesthesia. Another important setting is to control agitation during mechanical ventilation weaning.Materials and Methods: Retrospective audit in a 38-bed ICU about the sedation standards in our Unit. All patients admitted between May 2013 to April 2016 that received DX during their stay in the ICU were analyzed. Variables recorded: demographics, motive of ICU admission, indication for DX use, dosage and treatment duration. Use of other sedative or analgesic medication (propofol, midazolam, remifentanyl or fentanyl, haloperidol). DX effectiveness (agitation control, reduction of other drug`s dosage. etc) and interruption because of adverse effects. We also recorded ICU and hospital length of stay (LOS) and mortality.Results and Discussion: From a total of 8057 patients admitted, 57 (0,7%) received DX. 38 were male (66.7%) and mean age was 61 (SD u00b113.42). Admission was due to cardiac surgery (28.1%), cardiac arrest (15.8%), vascular surgery (10.5%), general surgery (7%), pneumonia (7%) and others (29.8%). Mortality was 24.6%. Indication for DX were agitation (75.4%), delirium (1.8%) and others such as hypertension (22.8%). We used mainly propofol as a sedative (80.7%) and remifentanyl or fentanyl (54.4%) and morphine chloride as analgesic (8.9%). Haloperidol was used in 9 patients (15.8%). Minimum dosis was 0.46 ug/kg/h (SD u00b10.21) and maximum was 1.05 ug/kg/h (SD u00b10.56). Mean duration of the therapy was 3.61 days (SD u00b12.86). DX was effective in 75.4% of the cases and previous analgesic/sedative drugs could be reduced or suspended in the 66.7%. There was no association between effectiveness and mortality, using agitation control (OR 1.3, 95% CI 0.3-5.5, p=0.51) or drugs reduction (OR 2.2, 95% IC 0.5-9.3, p=0.33). 11 patients were treated in more than one occasion; in those patients mean duration was 6.45 days (SD u00b14.108). In 4 cases (7%), DX was discontinued because of adverse events (bradycardia or atrioventricular block). 31 patients (54.4%) were tracheostomized.Conclusion: Although underused, dexmedetomidine controlled symptoms, specially agitation and delirium, and helped to reduced others drugs with minimum side effects. References: Chen K et al. Cochrane Database Syst Rev. 2015 Jan 6;1:CD010269Klompas M et al. Chest. 2016. doi:10.1378/chest.15-1389.