1Department of Pharmacy, University of Florida Health, Jacksonville, FL. 2Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH. 3The Ohio State University, College of Pharmacy, Columbus, OH. 4The Ohio State University Center for Biostatistics, Columbus, OH. 5University of Tennessee, College of Medicine, Memphis, TN. 6Semmes-Murphey Neurologic and Spine Institute, Memphis, TN. 7Department of Pharmacy, Methodist Healthcare-University Hospital, Memphis, TN. 8University of Tennessee, College of Pharmacy, Memphis, TN.
Crit Care Med. 2014 Jul;42(7):1696-702. doi: 10.1097/CCM.0000000000000328.
Dexmedetomidine and propofol are commonly used sedatives in neurocritical care as they allow for frequent neurologic examinations. However, both agents are associated with significant hemodynamic side effects. The primary objective of this study is to compare the prevalence of severe hemodynamic effects in neurocritical care patients receiving dexmedetomidine and propofol.
Multicenter, retrospective, propensity-matched cohort study.
Neurocritical care units at two academic medical centers with dedicated neurocritical care teams and board-certified neurointensivists.
Neurocritical care patients admitted between July 2009 and September 2012 were evaluated and then matched 1:1 based on propensity scoring of baseline characteristics.
Continuous sedation with dexmedetomidine or propofol.
A total of 342 patients (105 dexmedetomidine and 237 propofol) were included in the analysis, with 190 matched (95 in each group) by propensity score. The primary outcome of this study was a composite of severe hypotension (mean arterial pressure < 60 mm Hg) and bradycardia (heart rate < 50 beats/min) during sedative infusion. No difference in the primary composite outcome in both the unmatched (30% vs 30%, p = 0.94) or matched cohorts (28% vs 34%, p = 0.35) could be found. When analyzed separately, no differences could be found in the prevalence of severe hypotension or bradycardia in either the unmatched or matched cohorts.
Severe hypotension and bradycardia occur at similar prevalence in neurocritical care patients who receive dexmedetomidine or propofol. Providers should similarly consider the likelihood of hypotension or bradycardia before starting either sedative.
右美托咪定和丙泊酚是神经重症监护中常用的镇静剂，因为它们可以进行频繁的神经检查。然而，这两种药物都与显著的血液动力学副作用相关。本研究的主要目的是比较接受右美托咪定和丙泊酚的神经重症监护患者中严重血液动力学影响的发生率。
多中心、回顾性、倾向匹配队列研究。
两家学术医疗中心的神经重症监护病房，有专门的神经重症监护团队和经董事会认证的神经科医生。
2009 年 7 月至 2012 年 9 月期间入院的神经重症监护患者，根据基线特征的倾向评分进行评估，然后进行 1:1 匹配。
持续输注右美托咪定或丙泊酚镇静。
共有 342 名患者（105 名接受右美托咪定，237 名接受丙泊酚）纳入分析，190 名患者（每组 95 名）通过倾向评分匹配。本研究的主要结果是镇静剂输注过程中严重低血压（平均动脉压<60mmHg）和心动过缓（心率<50 次/分）的复合结果。在未匹配（30%比 30%，p=0.94）或匹配队列（28%比 34%，p=0.35）中均未发现主要复合结果的差异。单独分析时，在未匹配或匹配队列中均未发现严重低血压或心动过缓的发生率存在差异。
接受右美托咪定或丙泊酚的神经重症监护患者中严重低血压和心动过缓的发生率相似。在开始使用任何一种镇静剂之前，医务人员应同样考虑低血压或心动过缓的可能性。
