Venn M, Newman J, Grounds M
Department of Anaesthesia and Intensive Care, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex BN11 2DH, UK,
Intensive Care Med. 2003 Feb;29(2):201-7. doi: 10.1007/s00134-002-1579-9. Epub 2002 Nov 22.
To evaluate dexmedetomidine for sedation of patients in the medical ICU.
Prospective observational study in an intensive care unit of a university hospital. PATIENTS. Twelve ventilated patients with median APACHE II score 23 (range 10-26).
Patients received a loading dexmedetomidine infusion of 1 microg x kg(-1) over 10 min followed by a maintenance infusion rate of 0.2-0.7 microg x kg(-1) x h(-1) for up to 7 days. After experience with the first four patients this maintenance rate of infusion was increased to a maximum of 2.5 microg kg(-1) x h(-1). If required, propofol and morphine provided rescue sedation and analgesia, respectively.
The first four patients with dexmedetomidine infusion at 0.7 microg x kg(-1) x h(-1)all required rescue sedation with a propofol infusion. A protocol amendment allowed the next eight patients to receive higher dexmedetomidine infusions (mean 1.0+/- microg x kg(-1) x h(-1)). Five of the next eight patients did not required propofol, and two patients only required minimal propofol infusions (20-40 mg x h(-1)). A further patient, with hepatic encephalopathy, required a propofol at 50-100 mg x h(-1). Only modest falls in arterial pressure, heart rate and cardiac output were seen, and no rebound sequelae occurred on discontinuation of dexmedetomidine. Adverse cardiovascular events were nearly all confined to the initial loading dose period of dexmedetomidine.
Sedation with dexmedetomidine is efficacious in critically ill medical patients requiring mechanical ventilation in the intensive care unit. A reduction in loading infusion is advised, but higher maintenance infusions may be required to that seen previously in the postoperative ICU patient.
评估右美托咪定用于医学重症监护病房（ICU）患者镇静的效果。
在一所大学医院的重症监护病房进行的前瞻性观察研究。患者：12例接受机械通气的患者，急性生理与慢性健康状况评分系统（APACHE II）中位数为23分（范围10 - 26分）。
患者先在10分钟内静脉输注负荷剂量的右美托咪定1微克/千克，随后以0.2 - 0.7微克/千克·小时的维持输注速率持续输注长达7天。在对前4例患者进行治疗后，该维持输注速率提高至最大2.5微克/千克·小时。如有需要，丙泊酚和吗啡分别用于补救性镇静和镇痛。
前4例以0.7微克/千克·小时的速率输注右美托咪定的患者均需要丙泊酚输注进行补救性镇静。方案修订后，接下来的8例患者接受了更高剂量的右美托咪定输注（平均1.0±微克/千克·小时）。接下来的8例患者中有5例不需要丙泊酚，2例仅需要少量丙泊酚输注（20 - 40毫克/小时）。另有1例患有肝性脑病的患者需要50 - 100毫克/小时的丙泊酚输注。仅观察到动脉压、心率和心输出量有适度下降，停用右美托咪定后未出现反跳后遗症。不良心血管事件几乎都局限于右美托咪定的初始负荷剂量期。
右美托咪定镇静对于重症监护病房中需要机械通气的危重症医学患者有效。建议减少负荷输注量，但可能需要比术后ICU患者先前使用的剂量更高的维持输注量。
