Effects Of Dexmedetomidine For The Sedation On Mechanically Ventilated Patients In Intensive Care Unit

Objective to evaluate the off-label sedation for dexmedetomidine on mechanicaliy ventilated patients in intensive care unit(ICU) through observation of sedative validity (>24h) and clinic consequences like respiratory and haemodynamic parameters, safety and the duration of mechanical ventilation and ICU stay with dexmedetomidine against propofol on mechanically ventilated patients in ICU.Methods1.40invasive mechanical ventilated patients in ICU which were admitted to the standard and expected to ventilated for more than three days were randomly divided into two groups:dexmedetomidine group (D group,20cases) and propofol group (P group,20cases).Patients in two groups were combined with small doses of fentanyl for analgesia during the sedation.Fentanyl was infused at1.0μg.kg-1.h-1. The patients in D group were given a loading dose (1μg.kg-1) for more than10min and then maintained with O.2-O.7μg.kg-1.h-1;the patients in P group were given a loading dose (1mg.kg-1) for over10min and then maintained with1.0-3.0mg.kg-1.h-1until weaning. Depth of sedation was assessed using the Riker Sedation-Agitation Scale(SAS).The dose of sedation was regulated according to Riker Sedation-Agitation Scale maintain3to4sedative score. Additional sedation if required were provided by midazolam.2During the course, the changes in respiratory and haemodynamics parameters puls SAS values at pre-sedation,sedation for30min,1h,3h were observed and recorded;record the duration of mechanical ventilation，ICU length of stay in ICU patients;recored the occurrence of respiratory and cardiovascular adverse events and delirium.Result1Two groups of patients were able to achieve the target level of sedation SAS score3-4points right dexmedetomidine group vs propofol group SAS score was4.05±0.79vs3.81±0.62, the difference was not statistically significant (P>0.05).2The breathing rate, heart beat,blood pressure in all patients decreased significantly during sedation compared with pre-sedation (P<0.05), but as extension of infusion the respiratory and haemodynamics parameters improved,there were no significant difference in different points(P>0.05).3The duration of mechanical ventilation and ICU length of stay(LOS) in dexmedetodine group was slightly shorter than the propofol group, but the difference was not statistically significant (P> 0.05).4Two groups of patients’sedation-related adverse events were similar to each other(P>0.05).Conclusion1. Within an exact range of dosage, dexmedetomidine is comparable with propofol in sedative effect for ICU patients who receiving mechanical ventilation for a long time (>3days).2Dexmedetomidine represents a relatively stability in hemodynamics and fewer occurrence of respiratory depression during sedation.3.Dexmedetomidine appears fewer adverse effects.