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A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit.
Intensive Care Med. 2003 Feb; 29(2):201-7.IC

Abstract

OBJECTIVE

To evaluate dexmedetomidine for sedation of patients in the medical ICU.

DESIGN AND SETTING

Prospective observational study in an intensive care unit of a university hospital. PATIENTS. Twelve ventilated patients with median APACHE II score 23 (range 10-26).

INTERVENTIONS

Patients received a loading dexmedetomidine infusion of 1 microg x kg(-1) over 10 min followed by a maintenance infusion rate of 0.2-0.7 microg x kg(-1) x h(-1) for up to 7 days. After experience with the first four patients this maintenance rate of infusion was increased to a maximum of 2.5 microg kg(-1) x h(-1). If required, propofol and morphine provided rescue sedation and analgesia, respectively.

RESULTS

The first four patients with dexmedetomidine infusion at 0.7 microg x kg(-1) x h(-1)all required rescue sedation with a propofol infusion. A protocol amendment allowed the next eight patients to receive higher dexmedetomidine infusions (mean 1.0+/- microg x kg(-1) x h(-1)). Five of the next eight patients did not required propofol, and two patients only required minimal propofol infusions (20-40 mg x h(-1)). A further patient, with hepatic encephalopathy, required a propofol at 50-100 mg x h(-1). Only modest falls in arterial pressure, heart rate and cardiac output were seen, and no rebound sequelae occurred on discontinuation of dexmedetomidine. Adverse cardiovascular events were nearly all confined to the initial loading dose period of dexmedetomidine.

CONCLUSIONS

Sedation with dexmedetomidine is efficacious in critically ill medical patients requiring mechanical ventilation in the intensive care unit. A reduction in loading infusion is advised, but higher maintenance infusions may be required to that seen previously in the postoperative ICU patient.

Authors+Show Affiliations

Department of Anaesthesia and Intensive Care, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex BN11 2DH, UK, richard@svenn.freeserve.co.ukNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Clinical Trial, Phase II
Journal Article

Language

eng

PubMed ID

12594584

Citation

Venn, M, et al. "A Phase II Study to Evaluate the Efficacy of Dexmedetomidine for Sedation in the Medical Intensive Care Unit." Intensive Care Medicine, vol. 29, no. 2, 2003, pp. 201-7.
Venn M, Newman J, Grounds M. A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. Intensive Care Med. 2003;29(2):201-7.
Venn, M., Newman, J., & Grounds, M. (2003). A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. Intensive Care Medicine, 29(2), 201-7.
Venn M, Newman J, Grounds M. A Phase II Study to Evaluate the Efficacy of Dexmedetomidine for Sedation in the Medical Intensive Care Unit. Intensive Care Med. 2003;29(2):201-7. PubMed PMID: 12594584.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. AU - Venn,M, AU - Newman,J, AU - Grounds,M, Y1 - 2002/11/22/ PY - 2002/07/16/received PY - 2002/10/18/accepted PY - 2003/2/21/pubmed PY - 2003/6/21/medline PY - 2003/2/21/entrez SP - 201 EP - 7 JF - Intensive care medicine JO - Intensive Care Med VL - 29 IS - 2 N2 - OBJECTIVE: To evaluate dexmedetomidine for sedation of patients in the medical ICU. DESIGN AND SETTING: Prospective observational study in an intensive care unit of a university hospital. PATIENTS. Twelve ventilated patients with median APACHE II score 23 (range 10-26). INTERVENTIONS: Patients received a loading dexmedetomidine infusion of 1 microg x kg(-1) over 10 min followed by a maintenance infusion rate of 0.2-0.7 microg x kg(-1) x h(-1) for up to 7 days. After experience with the first four patients this maintenance rate of infusion was increased to a maximum of 2.5 microg kg(-1) x h(-1). If required, propofol and morphine provided rescue sedation and analgesia, respectively. RESULTS: The first four patients with dexmedetomidine infusion at 0.7 microg x kg(-1) x h(-1)all required rescue sedation with a propofol infusion. A protocol amendment allowed the next eight patients to receive higher dexmedetomidine infusions (mean 1.0+/- microg x kg(-1) x h(-1)). Five of the next eight patients did not required propofol, and two patients only required minimal propofol infusions (20-40 mg x h(-1)). A further patient, with hepatic encephalopathy, required a propofol at 50-100 mg x h(-1). Only modest falls in arterial pressure, heart rate and cardiac output were seen, and no rebound sequelae occurred on discontinuation of dexmedetomidine. Adverse cardiovascular events were nearly all confined to the initial loading dose period of dexmedetomidine. CONCLUSIONS: Sedation with dexmedetomidine is efficacious in critically ill medical patients requiring mechanical ventilation in the intensive care unit. A reduction in loading infusion is advised, but higher maintenance infusions may be required to that seen previously in the postoperative ICU patient. SN - 0342-4642 UR - https://www.unboundmedicine.com/medline/citation/12594584/A_phase_II_study_to_evaluate_the_efficacy_of_dexmedetomidine_for_sedation_in_the_medical_intensive_care_unit_ L2 - https://dx.doi.org/10.1007/s00134-002-1579-9 DB - PRIME DP - Unbound Medicine ER -