Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects

@article{Shehabi2004DexmedetomidineIF,
  title={Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects},
  author={Yahya Shehabi and Urban Ruettimann and Harriet Adamson and Richard Innes and Mathieu Ickeringill},
  journal={Intensive Care Medicine},
  year={2004},
  volume={30},
  pages={2188-2196}
}
Objective To assess the potential of dexmedetomidine for targeted sedation in complex Intensive Care (ICU) patients for >24 h.Design Prospective, open label, clinical trial.Setting Tertiary general ICU.Patients Twenty critically ill patients, mean APACHE II 23(±9).Interventions A continuous infusion of dexmedetomidine, median infusion time 71.5 (35–168) h, starting at 0.4μg·kg·h without a loading dose and adjusted (0.2–0.7μg·kg·h) to a target Ramsay Sedation Score (RSS) of 2–4. Rescue midazolam… 
Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial.
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At comparable sedation levels, dexmedetomidine-treated patients spent less time on the ventilator, experienced less delirium, and developed less tachycardia and hypertension.
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It is suggested that tachycardia, transient hypertension, and agitation are frequently observed in pediatric cardiac intensive care unit patients after discontinuing prolonged dexmedetomidine infusions.
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TLDR
Long-term safety of dexmedetomidine compared to its use for 24 h was confirmed and it was useful to maintain an adequate sedation level (RASS ≤ 0) during long-term infusion.
Comparison of clonidine and dexmedetomidine for short-term sedation of intensive care unit patients
  • U. Srivastava, M. Sarkar, +5 authors Yogita Dwivedi
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    Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine
  • 2014
TLDR
Hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients, however, the hemodynamic stability given byClonidine gives the latter an edge for sedation in patients on mechanical ventilation.
Evaluation of dexmedetomidine: safety and clinical outcomes in critically ill trauma patients.
TLDR
Higher doses of dexmedetomidine may result in higher incidence of hypotension, longer LOS, and increased concomitant analgesic, sedative, and antipsychotic use, requiring further evaluation in trauma patients.
Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation
TLDR
This pilot study suggests that in long-term sedation, DEX is comparable to SC in maintaining sedation targets of RASS 0 to −3 but not suitable for deep sedation (RASS −4 or less).
Role of dexmedetomidine in early extubation of the intensive care unit patients
Background and Aims: Patients on ventilatory support in intensive care unit (ICU) require sedation and analgesia to facilitate mechanical ventilation and endotracheal tube tolerance. The selection of
A new dosing protocol reduces dexmedetomidine-associated hypotension in critically ill surgical patients.
TLDR
It is found that use of a protocol that increases the time interval between dosage adjustments may reduce dexmedetomidine-associated hypotension.
The Effect of Dexmedetomidine on Agitation during Weaning of Mechanical Ventilation in Critically ill Patients
TLDR
Dexmedetomidine achieved rapid resolution of agitation and facilitated ventilatory weaning after failure of conventional therapy and its role as first-line therapy in ventilated, agitated patients warrants further investigation.
Long-Term Dexmedetomidine Use and Safety Profile Among Critically Ill Children and Neonates*
TLDR
Hemodynamic effects of dexmedetomidine did not limit long-term use in this diverse population of patients, and patients were more comfortable as evidenced by decreasing comfort scores.
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References

SHOWING 1-10 OF 14 REFERENCES
A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit
TLDR
Sedation with dexmedetomidine is efficacious in critically ill medical patients requiring mechanical ventilation in the intensive care unit, and a reduction in loading infusion is advised, but higher maintenance infusions may be required to that seen previously in the postoperative ICU patient.
Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive caret.
TLDR
Mean dexmedetomidine pharmacokinetic variables seen in postoperative, intensive care patients were similar to those previously found in volunteers, with the exception of the steady-state volume of distribution.
Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions.
TLDR
Despite ventilation and intubation, patients sedated with dexmedetomidine could be easily roused to cooperate with procedures (e.g. physiotherapy, radiology) without showing irritation.
Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit
TLDR
In conclusion, dexmedetomidine is a useful agent for the provision of postoperative analgesia and sedation in patients requiring intensive care and could be predicted from the known properties of alpha‐2 agonists.
Bispectral index-guided sedation with dexmedetomidine in intensive care: A prospective, randomized, double blind, placebo-controlled phase II study*
TLDR
Dexmedetomidine reduced propofol requirements and improved hemodynamic stability during bispectral index-guided intensive care unit sedation and analgesia in patients after surgery.
Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate.
TLDR
Overall, across all the DMED doses, the slope was decreased (P < .05) at all times after DMED, and the placebo group showed a progressive increase in the HVR slope.
Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation
TLDR
A randomized, controlled trial involving 128 adult patients who were receiving mechanical ventilation and continuous infusions of sedative drugs in a medical intensive care unit found that the intervention group increased the median duration of mechanical ventilation, as compared with 7.3 days in the control group.
Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care
TLDR
Dexmedetomidine provides important postsurgical analgesia and appears to have no clinically important adverse effects on respiration in the surgical patient who requires intensive care.
ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens.
OBJECTIVE To compare dexmedetomidine-based to propofol-based sedation after coronary artery bypass graft (CABG) surgery in the intensive care unit (ICU). DESIGN Randomized, open label. SETTING
The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery.
TLDR
It is concluded that dexmedetomidine attenuates increases in heart rate and plasma norepinephrine concentrations during emergence from anesthesia in vascular surgery patients.
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