A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit

Feb 21, 2003Intensive care medicine

Dexmedetomidine for sedation in medical intensive care: a phase II study

AI simplified

Circadian Biology on OpenScience ↗PubMed ↗DOI ↗

Abstract

Twelve ventilated patients with a median APACHE II score of 23 were evaluated for sedation with dexmedetomidine.

Initial dexmedetomidine infusions at 0.7 microg x kg(-1) x h(-1) required rescue sedation with propofol for all four patients.
After protocol changes, the mean dexmedetomidine infusion rate increased to 1.0 microg x kg(-1) x h(-1) for the next eight patients.
Five of the eight patients did not require propofol, while two needed only minimal doses (20-40 mg x h(-1)).
Modest decreases in arterial pressure, heart rate, and cardiac output were observed, with no rebound effects upon discontinuation.
Adverse cardiovascular events were primarily associated with the initial loading dose period.

AI simplified

OBJECTIVE: To evaluate dexmedetomidine for sedation of patients in the medical ICU.

DESIGN AND SETTING: Prospective observational study in an intensive care unit of a university hospital. PATIENTS. Twelve ventilated patients with median APACHE II score 23 (range 10-26).

INTERVENTIONS: Patients received a loading dexmedetomidine infusion of 1 microg x kg(-1) over 10 min followed by a maintenance infusion rate of 0.2-0.7 microg x kg(-1) x h(-1) for up to 7 days. After experience with the first four patients this maintenance rate of infusion was increased to a maximum of 2.5 microg kg(-1) x h(-1). If required, propofol and morphine provided rescue sedation and analgesia, respectively.

RESULTS: The first four patients with dexmedetomidine infusion at 0.7 microg x kg(-1) x h(-1)all required rescue sedation with a propofol infusion. A protocol amendment allowed the next eight patients to receive higher dexmedetomidine infusions (mean 1.0+/- microg x kg(-1) x h(-1)). Five of the next eight patients did not required propofol, and two patients only required minimal propofol infusions (20-40 mg x h(-1)). A further patient, with hepatic encephalopathy, required a propofol at 50-100 mg x h(-1). Only modest falls in arterial pressure, heart rate and cardiac output were seen, and no rebound sequelae occurred on discontinuation of dexmedetomidine. Adverse cardiovascular events were nearly all confined to the initial loading dose period of dexmedetomidine.

CONCLUSIONS: Sedation with dexmedetomidine is efficacious in critically ill medical patients requiring mechanical ventilation in the intensive care unit. A reduction in loading infusion is advised, but higher maintenance infusions may be required to that seen previously in the postoperative ICU patient.

Full Text

Full text is available at the source.

View full text (PDF) ↗View full text (HTML) ↗View full text ↗

A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit

Abstract

Full Text

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the circadian biology brief