Ruokonen Esko, Parviainen Ilkka, Jakob Stephan M, Nunes Silvia, Kaukonen Maija, Shepherd Stephen T, Sarapohja Toni, Bratty J Raymond, Takala Jukka
Department of Anesthesiology and Intensive Care Medicine, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland.
Intensive Care Med. 2009 Feb;35(2):282-90. doi: 10.1007/s00134-008-1296-0. Epub 2008 Sep 16.
To compare dexmedetomidine (DEX) with standard care (SC, either propofol or midazolam) for long-term sedation in terms of maintaining target sedation and length of intensive care unit (ICU) stay.
A pilot, phase III, double-blind multicenter study in randomized medical and surgical patients (n = 85) within the first 72 h of ICU stay with an expected ICU stay of >or=48 h and sedation need for >or=24 h after randomization. Patients were assigned to either DEX (<or=1.4 microg kg(-1) h(-1); n = 41) or SC (n = 44), with daily sedation stops.
Non-inferiority of DEX versus SC was not confirmed. Target Richmond agitation-sedation score (RASS) was reached a median of 64% (DEX) and 63% (SC) of the sedation time (ns). The length of ICU stay was similar in DEX and SC. Patients with RASS target 0-3 (DEX 78%, SC 80%) were at target sedation 74% (DEX) and 64% (SC) of the time (ns), whereas those with RASS target -4 or less reached the target 42% (DEX) and 62% (SC) of the time (P = .006). Post hoc analyses suggested shorter duration of mechanical ventilation for DEX (P = 0.025).
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). DEX had no effect on length of ICU stay. Its effects on other relevant clinical outcomes, such as duration of mechanical ventilation, should be tested further.
比较右美托咪定（DEX）与标准护理（SC，丙泊酚或咪达唑仑）用于长期镇静时在维持目标镇静及重症监护病房（ICU）住院时间方面的效果。
一项试点性、III期、双盲多中心研究，纳入ICU住院前72小时内预期ICU住院时间≥48小时且随机分组后镇静需求≥24小时的内科和外科随机患者（n = 85）。患者被分配至DEX组（≤1.4微克/千克/小时；n = 41）或SC组（n = 44），每日进行镇静中断。
未证实DEX不劣于SC。达到目标里士满躁动 - 镇静评分（RASS）的时间分别为DEX组镇静时间的中位数64%和SC组的63%（无显著差异）。DEX组和SC组的ICU住院时间相似。RASS目标为0 - 3的患者（DEX组78%，SC组80%）达到目标镇静的时间分别为DEX组的74%和SC组的64%（无显著差异），而RASS目标为 - 4或更低的患者达到目标的时间分别为DEX组的42%和SC组的62%（P = 0.006）。事后分析提示DEX组机械通气时间较短（P = 0.025）。
这项试点研究表明，在长期镇静中，DEX在维持RASS 0至 - 3的镇静目标方面与SC相当，但不适用于深度镇静（RASS - 4或更低）。DEX对ICU住院时间无影响。其对其他相关临床结局（如机械通气时间）的影响应进一步研究。
