Sato Tetsuya, Kawazoe Yu, Miyagawa Noriko, Yokokawa Yuta, Kushimoto Shigeki, Miyamoto Kyohei, Ohta Yoshinori, Morimoto Takeshi, Yamamura Hitoshi
Department of Emergency and Critical Care Medicine Tohoku University Hospital Sendai Japan.
Division of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai Japan.
Acute Med Surg. 2021 Apr 9;8(1):e644. doi: 10.1002/ams2.644. eCollection 2021 Jan-Dec.
There are no definitive data to determine whether age influences the effects of dexmedetomidine (DEX) treatment. Thus, we investigated whether older age was associated with more favorable sedative action by DEX in sepsis patients who required mechanical ventilation.
This study involved a post-hoc analysis of data from the Dexmedetomidine for Sepsis in the ICU Randomized Evaluation (DESIRE) trial. The patients were categorized based on median age into elderly and younger groups. The two groups were then compared during the first 7 days after ventilation based on proportion of patients with well-controlled sedation (Richmond Agitation-Sedation Scale score between -3 and +1), days free from delirium (based on the Confusion Assessment Method for ICU), and days free from coma (Richmond Agitation-Sedation Scale score between -4 and -5).
One hundred and one patients were assigned to the elderly group and 100 patients were assigned to the younger group. In the elderly group, 50 patients received DEX treatment and 51 patients received non-DEX treatment, with the DEX arm having significantly better-controlled sedation (range, 14-52% versus 16-27%; = 0.01). In the younger group, 50 patients received DEX treatment and 50 patients received non-DEX treatment, with no significant difference in the proportions of well-controlled sedation (range, 20-64% versus 24-60%; = 0.73). There were no significant differences in the numbers of days free from delirium or coma between the groups.
In elderly sepsis patients who require ventilation, dexmedetomidine could be more effective than other sedative agents for achieving proper sedation.
尚无确切数据来确定年龄是否会影响右美托咪定（DEX）治疗的效果。因此，我们研究了在需要机械通气的脓毒症患者中，高龄是否与DEX更有利的镇静作用相关。
本研究对重症监护病房右美托咪定治疗脓毒症随机评估（DESIRE）试验的数据进行事后分析。根据年龄中位数将患者分为老年组和年轻组。然后在通气后的前7天内，比较两组患者镇静控制良好（里士满躁动 - 镇静量表评分为 -3至 +1）、无谵妄天数（基于ICU谵妄评估方法）以及无昏迷天数（里士满躁动 - 镇静量表评分为 -4至 -5）的比例。
101例患者被分配到老年组，100例患者被分配到年轻组。在老年组中，50例患者接受DEX治疗，51例患者接受非DEX治疗，DEX组的镇静控制明显更好（范围分别为14 - 52% 对16 - 27%；P = 0.01）。在年轻组中，50例患者接受DEX治疗，50例患者接受非DEX治疗，镇静控制良好的比例无显著差异（范围分别为20 - 64% 对24 - 60%；P = 0.73）。两组之间无谵妄或昏迷天数的显著差异。
在需要通气的老年脓毒症患者中，右美托咪定在实现适当镇静方面可能比其他镇静剂更有效。
