Effect Of Dexmedetomidine On The Prognosis Of Mechanically Ventilated Patients With Severe Pneumonia

Objective:In retrospective studies,to investigate the effect of dexmedetomidine sedation on the prognostic outcome of mechanically ventilated patients with severe pneumonia in ICU.Methods:A total of 207 patients admitted to the ICU due to severe pneumonia from January 2018 to December 2022 in the First Affiliated Hospital of Nanchang University were enrolled,and were divided into M-D group(midazolam combined with dexmedetomidine),M group(midazolam alone sedation),and D group(dexmedetomidine alone sedation)according to the sedative drugs used in the treatment,with 109,40 and 58 patients,respectively.The differences in duration of mechanical ventilation,time of endotracheal intubation,and length of stay in ICU were compared between the three groups,and the basic information of patients when admitted to ICU,laboratory test results,whether vasoactive drugs were used for maintenance,whether ECMO was treated,and whether cardiovascular events occurred during hospitalization were recorded.The Kaplan-Meier method was used for survival analysis and Cox regression was used to analyze the risk factors for60-day all-cause mortality in patients with severe pneumonia.Results:A total of 207 patients were included in this study,of which 51(24.60%)died at60 days,including 24 deaths(22.00%)in M-D group,17 deaths in M group(42.50%),10 deaths in D group(17.20%),and mortality in M-D and D groups was lower than that in M group(22.0%,17.2% vs 42.5%,p=0.011).The proportion of patients in M-D and M groups undergoing ECMO treatment was higher than that in group D(12.80%,10.00% vs.0.00%,P=0.019).The proportion of patients in M-D and M groups using vasoactive drugs was higher than that in group D(85.30%,87.50% vs.67.20%,P=0.009).The ventilator time in group D was lower than that in group M-D and M(6.50 days vs.12.00 days,14.50 days,P=0.003).The duration of endotracheal intubation in group D was lower than that in group M(10.00 days vs.15.00 days and 16.50 days,P=0.006).The days spent in ICU were similar in the M-D,M,and D groups,with no statistically significant difference.Multivariate COX regression analysis manifested that age ≥ 60 years(HR 3.56,95% CI 1.59-7.97,P=0.011),APACHEII score ≥30(HR 2.35,95% CI 1.02-5.38,P=0.044),and need for vasoactive drugs(HR 6.07,95% CI 1.35-27.30,P=0.018)were associated with60-day mortality in patients with severe pneumonia.Conclusions:1.In patients with severe pneumonia requiring mild to moderate sedation,patients in the dexmedetomidine group had shorter duration of mechanical ventilation than midazolam.2.Patients treated with dexmedetomidine sedation were less likely to die at 60 days than those who were sedated with midazolam alone.3.Age≥ 60 years old,APACHEII score ≥30,and need for vasoactive drugs may be independent risk factors for death in patients with severe pneumonia.