Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland.
Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
Acta Anaesthesiol Scand. 2021 Nov;65(10):1447-1456. doi: 10.1111/aas.13970. Epub 2021 Aug 22.
Dexmedetomidine has been suggested to be a promising sedative for patients with Covid-19 infection (CV19). However, use of dexmedetomidine is limited by its heart rate (HR) and arterial blood pressure lowering effects. Moreover, CV19 is associated with cardiac manifestations including bradyarrythmias. The hemodynamic effects of dexmedetomidine have not been previously studied in CV19 patients. We evaluated the effects of dexmedetomidine on hemodynamic and respiratory parameters of CV19 patients.
In this single center study, all CV19 patients receiving dexmedetomidine for sedation during a one year period were included. Our primary outcomes included changes in HR, mean arterial pressure (MAP), respiratory rate (RR), partial oxygen pressure of arterial blood/fraction of inspired oxygen-ratio (PF-ratio), and Richmond Agitation and Sedation Score (RASS) during dexmedetomidine administration.
We identified 39 patients with a mean (SD) age of 58.3 (12.7) years. After initiation of dexmedetomidine, HR decreased by 16.9 (3.3) beats/min (95% CI 9.5-22.4; p < 0.001). During the 12-hour follow-up period, HR decrease was significant at 2 to 12 h. Incident bradycardia (<45/min) was reported in 12 (30.8%) patients and it was associated with lower plasma C-reactive protein, Pro-calcitonin, and troponin T levels. There was no change in MAP compared to baseline. Dexmedetomidine administration was associated with improvement of PF-ratio (p < 0.001) and with decrease of RASS (p = 0.004).
Dexmedetomidine is an effective sedative for CV19 patients and may improve their oxygenation. However, dexmedetomidine administration is associated with marked decline in HR and with a high incidence of bradycardia in patients with CV19.
右美托咪定被认为是治疗 COVID-19 感染（CV19）患者的一种有前途的镇静剂。然而，右美托咪定的使用受到其降低心率（HR）和动脉血压的作用的限制。此外，CV19 与包括心动过缓在内的心脏表现有关。右美托咪定对 CV19 患者的血液动力学影响尚未得到研究。我们评估了右美托咪定对 CV19 患者血液动力学和呼吸参数的影响。
在这项单中心研究中，纳入了在一年期间接受右美托咪定镇静治疗的所有 CV19 患者。我们的主要结局包括在右美托咪定给药期间 HR、平均动脉压（MAP）、呼吸频率（RR）、动脉血氧分压/吸入氧分数比（PF-ratio）和 Richmond 躁动和镇静评分（RASS）的变化。
我们确定了 39 名年龄（标准差）为 58.3（12.7）岁的患者。开始使用右美托咪定后，HR 下降 16.9（3.3）次/分（95%置信区间 9.5-22.4；p<0.001）。在 12 小时的随访期间，2 至 12 小时 HR 下降显著。报告了 12 例（30.8%）心动过缓（<45 次/分），且与较低的血浆 C 反应蛋白、降钙素原和肌钙蛋白 T 水平相关。与基线相比，MAP 无变化。右美托咪定给药与 PF-ratio 的改善相关（p<0.001），与 RASS 的降低相关（p=0.004）。
右美托咪定是治疗 CV19 患者的有效镇静剂，可能改善其氧合。然而，右美托咪定给药与 CV19 患者 HR 明显下降以及心动过缓的发生率高有关。
