Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation

Ruokonen, Esko; Parviainen, Ilkka; Jakob, Stephan M.; Nunes, Silvia; Kaukonen, Maija; Shepherd, Stephen T.; Sarapohja, Toni; Bratty, J R; Takala, Jukka

doi:10.1007/s00134-008-1296-0

Cited by 193 publications

(169 citation statements)

References 25 publications

(43 reference statements)

Supporting

Mentioning

150

Contrasting

Unclassified

Order By: Relevance

“…18,27,29 A number of studies have demonstrated the safe use of dexmedetomidine for longer than 24 hours and in some cases up to 30 days. 28,[30][31][32] At NCMC, dexmedetomidine is routinely used for longer than 24 hours in the ICU. The manufacturers' recommended dosing range for dexmedetomidine was initially 0.2 to 0.7 mcg/kg/h.…”

Section: Dexmedetomidine In Alcohol Withdrawalmentioning

confidence: 99%

Retrospective Review of Critically Ill Patients Experiencing Alcohol withdrawal: Dexmedetomidine versus Propofol and/or Lorazepam Continuous Infusions

et al. 2015

View full text Add to dashboard Cite

Background: Alcohol withdrawal symptoms can be difficult to manage and may lead to an intensive care unit (ICU) admission. Patients experiencing severe alcohol withdrawal often require high doses of sedatives, which can lead to respiratory depression and the need for endotracheal intubation. Dexmedetomidine, an alpha-2 adrenoreceptor agonist, provides adequate sedation with little effect on respiratory function when compared to other sedatives. Objective: To evaluate sedation with a continuous infusion of dexmedetomidine versus propofol and/or lorazepam in critically ill patients experiencing alcohol withdrawal. Methods: A retrospective chart review was conducted on ICU admissions between March 2002 and April 2009 for alcohol withdrawal patients who necessitated treatment with a continuous infusion of dexmedetomidine, propofol, and/or lorazepam. Primary outcomes included the incidence of mechanical ventilation, length of mechanical ventilation (if applicable), and ICU and hospital length of stay. Results: Fifteen patients were treated with a continuous infusion of dexmedetomidine, and 17 were treated with an infusion of propofol and/or lorazepam. Two patients (13.3%) required intubation and mechanical ventilation in the dexmedetomidine group versus 10 (58.8%) in the propofol and/or lorazepam group (P = .006). Length of stay in the ICU was 53 hours for patients treated with dexmedetomidine versus 114.9 hours in the propofol and/or lorazepam group (P = .016). Hospital length of stay was less for the dexmedetomidine group, 135.8 hours versus 241.1 hours in the propofol and/or lorazepam group (P = .008). Conclusions: Dexmedetomidine use was associated with a decrease in the incidence of endotracheal intubation when used to sedate patients experiencing alcohol withdrawal. Patients transferred to a lower level of care faster and were discharged from the hospital sooner when treated with dexmedetomidine.

show abstract

Section: Dexmedetomidine In Alcohol Withdrawalmentioning

confidence: 99%

Retrospective Review of Critically Ill Patients Experiencing Alcohol withdrawal: Dexmedetomidine versus Propofol and/or Lorazepam Continuous Infusions

et al. 2015

View full text Add to dashboard Cite

show abstract

“…gov/ct2/show/NCT01862016) uses a combination of APRV+SV b) thus we surmise that conventional sedative agents were selected inappropriately: alpha-2 agonists [13,122] do not suppress the respiratory drive [94], but suppress the emergence delirium. Non-conventional sedation with alpha-2 agonists is by itself unlikely to modify outcome [146,147]: by contrast, the combination of stringent spontaneous ventilation and alpha-2 agonists is mandatory in order to achieve superiority [148] Two final observations are required, namely: a) would this alternative strategy be a failure (tachypnea, high or low Vt, acidosis, absence of improvement of P/F, etc. ), reverting early to proning+CMV+muscle relaxation [2,63] (36).…”

Section: Sedationmentioning

confidence: 99%

Early severe acute respiratory distress syndrome: What’s going on? Part II: controlled vs. spontaneous ventilation?

Petitjeans

Pichot

Ghignone

et al. 2016

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

The second part of this overview on early severe ARDS delineates the pros and cons of the following: a) controlled mechanical ventilation (CMV: lowered oxygen consumption and perfect patient-to-ventilator synchrony), to be used during acute cardio-ventilatory distress in order to "buy time" and correct circulatory insufficiency and metabolic defects (acidosis, etc.); b) spontaneous ventilation (SV: improved venous return, lowered intrathoracic pressure, absence of muscle atrophy). Given a stabilized early severe ARDS, as soon as the overall clinical situation improves, spontaneous ventilation will be used with the following stringent conditionalities: upfront circulatory optimization, upright positioning, lowered VO 2 , lowered acidotic and hypercapnic drives, sedation without ventilatory depression and without lowered muscular tone, as well as high PEEP (titrated on transpulmonary pressure, or as a second best: "trial"-PEEP) with spontaneous ventilation + pressure support (or newer modes of ventilation). As these propositions require evidence-based demonstration, the reader is reminded that the accepted practice remains, in 2016, controlled mechanical ventilation, muscle relaxation and prone position. Anestezjologia Intensywna Terapia 2016, tom 48, nr 5, 354-366Key words: acute respiratory distress syndrome, ARDS, severe ARDS; acute hypoxic non-hypercapnic respiratory failure; driving pressure; tidal volume, Vt, low tidal volume, ultra-low tidal volume; positive end-expiratory pressure, PEEP; transpulmonary pressure; controlled mechanical ventilation; spontaneous ventilation; spontaneous breathing; pressure support, airway pressure release ventilation; sedation, cooperative sedation; alpha-2 adrenergic agonist, clonidine, dexmedetomidineThe previous chapter overviewed, for residents rotating through the critical care unit (CCU), basic pathophysiology required to analyze early severe acute respiratory distress syndrome (ARDS). An emphasis was placed on spontaneous ventilation both in the setting of the healthy volunteer and of severe ARDS. This chapter will address the pros and cons of controlled mechanical ventilation, with the help of muscle relaxation, as opposed to the putative advantages of spontaneous ventilation. So far, spontaneous ventilation has not achieved evidence-based demonstration: thus, as in part I, conjectures are within [….], following [1]. i. MUSCLE RELAXATiON VERSUS SPONTANEOUS VENTiLATiON?When muscle relaxation is considered, the overall picture appears to be simplified with 48 h of muscle relaxation [2]. A sober interpretation may be considered. a. Muscle relaxationIn severe ARDS (P/F < 120), muscle relaxation [2] lowered the mortality (45 to 31%; difference of −32%; P = 0.04), multiple organ failure (MOF), and barotrauma and led to more ventilator-free days and identical CCU-acquired paresis. Muscle relaxation was hypothesized to minimize excessive transpulmonary pressure, patient-to-ventilator asynchrony [2], ventilator-induced lung injury (VILI), atelectrauma, overdistension,...

show abstract

“…La dexmedetomedina ha demostrado tener una más baja incidencia de delirium al compararla con morfina 94 , haloperidol 95 , propofol 96 , midazolam 96,97 y lorazepam 98 . Sin embargo, un reciente meta-análisis no logró demostrar un impacto positivo en la incidencia de delirium en el grupo dexmedetomedina 99 .…”

Section: Alfa 2 Agonistaunclassified

Delirium postoperatorio: una consecuencia del envejecimiento poblacional

et al. 2014

Rev. méd. Chile

View full text Add to dashboard Cite

show abstract

Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation

Cited by 193 publications

References 25 publications

Retrospective Review of Critically Ill Patients Experiencing Alcohol withdrawal: Dexmedetomidine versus Propofol and/or Lorazepam Continuous Infusions

Retrospective Review of Critically Ill Patients Experiencing Alcohol withdrawal: Dexmedetomidine versus Propofol and/or Lorazepam Continuous Infusions

Early severe acute respiratory distress syndrome: What’s going on? Part II: controlled vs. spontaneous ventilation?

Delirium postoperatorio: una consecuencia del envejecimiento poblacional

Contact Info

Product

Resources

About