A comparison on sedative effects between dexmedetomidine and midazolam for severe patients undergoing mechanical ventilation in intensive care unit
10.3969/j.issn.1008-9691.2015.03.020
- VernacularTitle:右美托咪定与咪达唑仑在机械通气 重症患者镇静治疗中的比较研究
- Author:
Beibei ZHENG
;
Difen WANG
;
Jiangquan FU
- Publication Type:Journal Article
- Keywords:
Dexmedetomidine;
Midazolam;
Sedation;
Mechanical ventilation
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2015;22(3):307-311
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe the sedative effects and analyze the cost-benefit of dexmedetomidine and midazolam for severe patients undergoing mechanical ventilation (MV) in intensive care unit (ICU). Methods A prospective randomized controlled trial was conducted. Eighty patients undergoing MV (24 hours < time of MV < 72 hours) with tracheal intubation and necessity of analgesic therapy in ICU from January 2014 to October 2014 in Affiliated Hospital of Guiyang Medical College were divided into midazolam group (39 cases) and dexmedetomidine group (41 cases) by random numerical table method. Both groups used intravenous continuous pump infusion of fentanyl 0.7 - 1.5μg·kg-1·h-1 as an analgesic therapy. The analgesic goal was critical care pain observation tool (COPT) score kept at 0 - 3, and the score was taken once per hour; when COPT score > 4, 0.5μg/kg fentanyl was added, when the analgesic goal was reached, the sedative treatment was given. In midazolam group, the patients received midazolam whose loading dose was 0.05 mg/kg intravenous injection (IV) in 2 minutes, followed by continuous IV pump infusion 0.03 - 0.30 mg·kg-1·h-1. In dexmedetomidine group, the patients received dexmedetomidine whose loading dose was slowly intravenous pump infusion of 0.5 - 1.0μg/kg, followed by continuous pump IV infusion of 0.2 - 0.7μg·kg-1·h-1; the sedation goal was richmond agitation-sedation scale (RASS) at 0 - 2, the score being taken once per hour, and as RASS > 0 point, the dosage of sedative was increased, and as RASS < -2, the dosage of sedative was reduced or discontinued. During the course of study, the heart rate (HR), blood pressure, the amount of sedative and analgesic used, duration of MV, extubation time, ICU stay time, total costs of sedative and fentanyl drugs, total ICU treatment costs and adverse reactions of patients were observed.Results Compared with midazolam group, the total amount of sedative used (mg/kg: 0.03±0.01 vs. 3.35±1.39), the dose of sedative used per hour (μg·kg-1·h-1: 0.66±0.13 vs. 59.78±19.44), the dose of fentanyl used (μg·kg-1·h-1: 0.40±0.21 vs. 0.57±0.26), the total costs of fentanyl used per hour (yuan: 1.41±0.86 vs. 2.00±0.84), the total costs in ICU per hour (yuan: 264.42±99.55 vs. 297.80±138.70) in dexmedetomidine group were significantly less (allP < 0.05); compared with midazolam group, the total costs of sedative in dexmedetomidine group was significantly higher (yuan: 8.97±5.05 vs. 7.78±4.22); the duration of MV [hours: 43.58 (39.83, 53.58) vs. 58.58 (46.17, 65.50)], extubation time [hours: 1.00 (1.67, 0.58) vs. 3.67 (2.00, 5.50)] and the time for staying in ICU [hours: 57.25 (47.33, 67.37) vs. 75.58 (64.67, 90.83)] were significantly shorter in dexmedetomidine group (allP < 0.05); the incidences of adverse reactions in dexmedetomidine group were significantly higher [hypotension: 29.27% (12/41) vs. 7.69% (3/39), bradycardia: 24.39% (10/41) vs. 5.13% (2/39), bothP < 0.05]; the incidence of delirium in dexmedetomidine group was lower [2.43% (1/41) vs. 15.38% (6/39),P < 0.05].Conclusion For ICU patients, dexmedetomidine is an ideal effective sedative, as it may shorten the duration of MV, the time for extubation, the period staying in ICU, reduce the dosage of analgesic used and the cost of treatment in ICU.
