Department of Pharmacy, Yale New Haven Health, 20 York Street, New Haven, CT 06510, United States of America; Clinical Redesign, Yale New Haven Health, 200 Orchard Street, New Haven, CT 06511, United States of America.
Department of Pharmacy, Virginia Commonwealth University Medical Center, 1250 E. Marshall Street, Richmond, VA 23219, United States of America.
J Crit Care. 2020 Dec;60:79-83. doi: 10.1016/j.jcrc.2020.07.021. Epub 2020 Jul 24.
Although guidelines recommend dexmedetomidine (DEX) or propofol (PRO) as preferred sedatives in critically ill adults, comparisons in neurocritical care (NCC) are limited. We aimed to evaluate the clinical utility and safety of DEX compared with PRO in NCC setting.
This retrospective, multicenter, observational cohort study conducted at three tertiary academic hospitals with Level 1 Trauma Center and Comprehensive Stroke Center designations, compared the clinical indication and safety of DEX vs PRO in patients in NCC setting.
179 patients were included (94 DEX and 85 PRO), median age of 58, 49% were male (DEX) and 58% were male (PRO). PRO was more commonly used to manage agitation. DEX was more commonly used for facilitating extubation, alcohol withdrawal, and sedation during frequent neurologic assessments. Mean Glasgow Coma Scale scores were higher in DEX group (11 vs. 9; p = .04). The duration of either infusions, mechanical ventilation, and lengths of stay were similar. No difference was observed in hypotension or bradycardia rates. Death was significantly higher with PRO (DEX 10% vs. PRO 22%; p = .02).
DEX and PRO were used for distinct indications in our cohort. Adverse effect profiles and clinical outcome, in the cohorts are largely similar.
尽管指南建议将右美托咪定（DEX）或丙泊酚（PRO）作为危重症成人的首选镇静剂，但在神经重症监护（NCC）中的比较有限。我们旨在评估 DEX 与 PRO 在 NCC 环境中的临床实用性和安全性。
这项回顾性、多中心、观察性队列研究在三家具有 1 级创伤中心和综合卒中中心指定的三级学术医院进行，比较了 DEX 与 PRO 在 NCC 环境中患者的临床适应证和安全性。
共纳入 179 例患者（94 例 DEX 和 85 例 PRO），中位年龄为 58 岁，49%为男性（DEX），58%为男性（PRO）。PRO 更常用于治疗躁动。DEX 更常用于促进拔管、酒精戒断和频繁神经评估时的镇静。DEX 组的格拉斯哥昏迷评分平均值较高（11 分比 9 分；p=0.04）。两种输注、机械通气和住院时间的持续时间相似。低血压或心动过缓的发生率无差异。PRO 的死亡率明显更高（DEX 为 10%，PRO 为 22%；p=0.02）。
在我们的队列中，DEX 和 PRO 用于不同的适应证。两组的不良效应谱和临床结局基本相似。
