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Dexmedetomidine in medical cardiac intensive care units. Data from a multicenter prospective registry.
International Journal of Cardiology ( IF 3.5 ) Pub Date : 2020-04-06 , DOI: 10.1016/j.ijcard.2020.04.002
Roberto Mateos Gaitan 1 , Lourdes Vicent 2 , Oriol Rodriguez-Queralto 3 , Esteban Lopez-de-Sa 4 , Ane Elorriaga 5 , Gemma Pastor 6 , Jordi Bañeras 7 , Beatriz Lorenzo 8 , Juan Carlos García-Rubira 8 , Miguel Corbi 9 , Albert Ariza 3 , Manuel Martínez-Sellés 10
Affiliation  

BACKGROUND Dexmedetomidine induces cooperative and arousable sedation. Our aim was to analyze dexmedetomidine use in medical cardiac intensive care units (CICU). METHODS Multicenter prospective registry of patients treated with dexmedetomidine in CICU. Consecutive inclusion during a 12-month period. RESULTS A total of 410 patients were included, mean age was 67.4 ± 13.9 years, and 94 (22.9%) were women. Before using dexmedetomidine, 247 patients (60.2%) had delirium, 48 developed delirium after dexmedetomidine use. In 178 (43.4%) dexmedetomidine was used during weaning from mechanical ventilation, with a reintubation rate of 10.1%, early reintubation rate (<24 h) 1.7%. Seventy-seven patients (18.8%) died during admission. Dexmedetomidine mean dose infusion was 0.51 ± 0.25 μ/kg/h, during a median of 34 h (interquartile range 12-78 h). Three hundred forty-eight patients received adjuvant sedatives (84.9%). Sixty-eight patients (16.6%) had adverse effects. The most frequent adverse effects were hypotension with systolic blood pressure <80 mmHg (44 patients - 10.7%), bradycardia <40 beats per minute (15 patients - 3.7%), and both bradycardia and hypotension (4 patients - 1.0%). Patients with adverse effects received more frequently inotropes (53 [81.6%] vs. 212 [65.4%], p = 0.02) and fewer adjuvant sedatives (49 [75.4%] vs. 282 [87.0%], p = 0.01). The independent predictors of adverse effects were inotropes use (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.30-5.74, p = 0.008) and lack of adjuvant sedatives (OR 3.03, 95% CI 1.49-6.26, p = 0.002). CONCLUSION Dexmedetomidine safety for medical CICU patients seems to be similar to that for general intensive care unit patients. Inotropes and lack of adjuvant sedatives were associated with adverse effects.

中文翻译:

医疗心脏重症监护室中的右美托咪定。来自多中心预期注册表的数据。

背景技术右美托咪定诱导协同和可引起的镇静作用。我们的目的是分析右旋美托咪定在医疗心脏重症监护病房(CICU)中的使用情况。方法对在CICU中接受右美托咪定治疗的患者进行多中心前瞻性登记。在12个月内连续收录。结果共纳入410例患者,平均年龄为67.4±13.9岁,其中94例(22.9%)为女性。使用右美托咪定之前,有247例患者(60.2%)出现ir妄,使用右美托咪定后有48例出现developed妄。178名(43.4%)的机械通气断奶期间使用了右美托咪定,其再插管率为10.1%,早期再插管率(<24 h)为1.7%。入院时有77名患者(18.8%)死亡。右美托咪定的平均剂量输注为0.51±0.25μ/ kg / h,中位数为34小时(四分位间距为12-78小时)。348例患者接受了辅助镇静剂(84.9%)。六十八名患者(16.6%)有不良反应。最常见的不良反应是收缩压<80 mmHg的低血压(44例-10.7%),心动过速<40次/分钟(15例-3.7%)以及心动过缓和低血压(4例-1.0%)。有不良反应的患者更经常使用正性肌力药物(53 [81.6%]比212 [65.4%],p = 0.02)和较少的辅助镇静剂(49 [75.4%]对282 [87.0%],p = 0.01)。不良反应的独立预测因素是使用正性肌力药物(比值比[OR] 2.73,95%置信区间[CI] 1.30-5.74,p = 0.008)和缺乏辅助镇静剂(OR 3.03,95%CI 1.49-6.26,p = 0.002)。结论右美托咪定对CICU医疗患者的安全性似乎与普通重症监护病房患者相似。正性肌力药和缺乏辅助镇静剂与不良反应有关。
更新日期:2020-04-06
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