Department of Pharmacy, Banner-University Medical Center Phoenix, Phoenix, AZ, USA.
Care Transformation, Banner-University Medical Center Phoenix, Phoenix, AZ, USA.
J Intensive Care Med. 2020 Dec;35(12):1536-1545. doi: 10.1177/0885066619884548. Epub 2019 Oct 31.
Nonbenzodiazepines are preferred for continuous sedation in mechanically ventilated intensive care unit (ICU) patients. Although dexmedetomidine and propofol have blood pressure lowering properties, limited data exist about the hemodynamic effects of concomitant administration. The purpose of this study was to compare the adverse hemodynamic event rate with concomitant dexmedetomidine and propofol compared to either agent alone in mechanically ventilated ICU patients.
This retrospective cohort study was conducted at a university medical center. Adult ICU patients (≥18 years) admitted between October 20, 2015, and January 25, 2018, and administered concurrent dexmedetomidine and propofol or either agent alone for ≥24 hours were included. Mean arterial pressure, heart rate, and sedative dosing requirements were assessed from initiation to 72 hours after initiation. The primary end point was comparing the incidence of hypotension among study groups. Secondary aims compared the incidence of tachycardia and bradycardia as well as clinical outcomes.
Overall, 276 patients were included among combination (n = 93), dexmedetomidine (n = 91), and propofol (n = 92) groups. The incidence of hypotension was significantly higher in patients administered concomitant dexmedetomidine and propofol (62.4%) compared to those administered dexmedetomidine (23.1%) or propofol (23.9%) alone ( < .0001). Adjunctive dexmedetomidine with propofol was also associated with higher rates of clinically relevant hypotension requiring treatment ( = .048). The tachycardia incidence in the concomitant, dexmedetomidine, and propofol groups were 30.1%, 28.6%, and 14.1%, respectively ( = 02). Only 1.4% (n = 4) of all study patients developed bradycardia. Concomitant therapy was an independent risk factor of hypotension compared to either dexmedetomidine (odds ratio [OR]: 6.7, 95% confidence interval [CI]: 2.61-17.3, < .0001) or propofol (OR: 2.89, 95% CI: 1.24-6.74, = .014) monotherapy. Patients experiencing hypotension were associated with worse clinical outcomes.
Concomitant dexmedetomidine and propofol use in mechanically ventilated patients increased the risk of hypotensive events. Adjunctive dexmedetomidine with propofol administration in the critically ill warrants caution.
非苯二氮䓬类药物是机械通气重症监护病房（ICU）患者连续镇静的首选药物。虽然右美托咪定和丙泊酚具有降低血压的特性，但关于同时使用这两种药物的血流动力学影响的数据有限。本研究的目的是比较同时使用右美托咪定和丙泊酚与单独使用这两种药物相比，机械通气 ICU 患者不良血流动力学事件的发生率。
这是一项在大学医学中心进行的回顾性队列研究。纳入 2015 年 10 月 20 日至 2018 年 1 月 25 日期间入住 ICU 并接受至少 24 小时同时使用右美托咪定和丙泊酚或单独使用其中一种药物的成年 ICU 患者。从开始使用药物到开始后 72 小时，评估平均动脉压、心率和镇静药物剂量需求。主要终点是比较研究组中低血压的发生率。次要目的是比较心动过速和心动过缓的发生率以及临床结局。
总体而言，共有 276 名患者被纳入联合（n = 93）、右美托咪定（n = 91）和丙泊酚（n = 92）组。与单独使用右美托咪定（23.1%）或丙泊酚（23.9%）相比，同时使用右美托咪定和丙泊酚的患者低血压发生率显著更高（62.4%）（<.0001）。右美托咪定与丙泊酚联合使用还与更高的需要治疗的临床相关低血压发生率相关（= 0.048）。联合、右美托咪定和丙泊酚组的心动过速发生率分别为 30.1%、28.6%和 14.1%（= 0.2）。所有研究患者中只有 1.4%（n = 4）发生心动过缓。与单独使用右美托咪定（比值比[OR]：6.7，95%置信区间[CI]：2.61-17.3，<.0001）或丙泊酚（OR：2.89，95% CI：1.24-6.74，= 0.014）相比，同时使用这两种药物是低血压的独立危险因素。发生低血压的患者临床结局更差。
在机械通气患者中同时使用右美托咪定和丙泊酚会增加发生低血压事件的风险。在危重症患者中，辅助使用右美托咪定与丙泊酚应谨慎。
