Patidar Atul Kumar, Khanna Puneet, Kashyap Lokesh, Ray Bikash R, Maitra Souvik
Department of Anesthesiology, Critical Care & Pain Medicine, All India Institute of Medical Sciences, Delhi, India.
J Intensive Care Med. 2025 Apr;40(4):379-387. doi: 10.1177/08850666241288141. Epub 2024 Oct 7.
Delirium frequently occurs in the acute phase of sepsis and is associated with increased ICU and hospital length of stay, duration of mechanical ventilation, and higher mortality rates. We utilized the Near-Infrared Spectroscopy monitor to measure and compare the regional cerebral oxygen saturation in mechanically ventilated patients of sepsis receiving either dexmedetomidine or propofol sedation and assessed the association between delirium and regional cerebral oxygen saturation. A single center prospective randomized control trial conducted over a period of two years, 54 patients were included, equally divided between propofol and dexmedetomidine groups. Patients received a blinded study drug, propofol (10 mg/mL) or dexmedetomidine (5 mcg/mL) via infusion pump according to randomization. Infusion rates were adjusted every 10 min based on weight-based titration tables, aiming for target sedation (RASS -2 to 0). Management components included pain monitoring using the CPOT score and delirium assessment using CAM-ICU score. Dexmedetomidine group showed higher mean regional cerebral oxygen saturation as compared to propofol group ( = .036). No significant differences were found in mechanical ventilation or ICU stay durations, delirium-free days, or sedation cessation reasons. Delirium occurred in 36 patients, with lower mean regional cerebral oxygen saturation as compared to non-delirious patients. The dexmedetomidine group had higher regional cerebral oxygen saturation compared to the propofol group. Delirious patients showed lower cerebral oxygen saturation than non-delirious patients, suggesting a link between sedation type, cerebral oxygenation, and delirium. REF/2021/11/048655 N.
谵妄在脓毒症急性期经常发生，且与重症监护病房（ICU）住院时间延长、医院住院时间延长、机械通气时间延长以及更高的死亡率相关。我们使用近红外光谱监测仪测量并比较接受右美托咪定或丙泊酚镇静的脓毒症机械通气患者的局部脑氧饱和度，并评估谵妄与局部脑氧饱和度之间的关联。一项为期两年的单中心前瞻性随机对照试验，纳入了54例患者，丙泊酚组和右美托咪定组各27例。患者根据随机分组接受盲法研究药物，通过输液泵输注丙泊酚（10mg/mL）或右美托咪定（5mcg/mL）。根据基于体重的滴定表每10分钟调整一次输注速率，目标是达到目标镇静水平（RASS -2至0）。管理内容包括使用CPOT评分进行疼痛监测以及使用CAM-ICU评分进行谵妄评估。与丙泊酚组相比，右美托咪定组的平均局部脑氧饱和度更高（P = 0.036）。在机械通气时间、ICU住院时间、无谵妄天数或镇静终止原因方面未发现显著差异。36例患者发生了谵妄，与未发生谵妄的患者相比，其平均局部脑氧饱和度较低。与丙泊酚组相比，右美托咪定组的局部脑氧饱和度更高。发生谵妄的患者脑氧饱和度低于未发生谵妄的患者，这表明镇静类型、脑氧合与谵妄之间存在联系。REF/2021/11/048655 N.
