Observation of cardiovascular adverse events of different sedatives in patients with mechanical ventilation in intensive care unit_West China Medical Journal

Authors：

YANG Mingquan , LIU Yang ,  ZHOU Jie

Intensive Care Unit, the First Peoples’ Hospital of Zigong, Zigong, Sichuan 643000, P. R. China;

Corresponding?author：

ZHOU Jie, Email: 3171994066@qq.com

Keywords：

Mechanical ventilation; Dexmedetomidine; Midazolam; Adverse events; Safety

DOI：

10.7507/1002-0179.201606168

Video：

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Objective To observe the incidence rate of cardiovascular adverse events and evaluate the safety of dexmedetomidine or midazolan sedation in patients with long-term mechanical ventilation in intensive care unit (ICU). Methods From January 2014 to December 2015, patients admitted to ICU aged ≥18 years with mechanical ventilation time ≥48 hours were randomly divided into dexmetomidine group (group D) and midazolam group (group M). Adverse events such as cardiovascular events during sedation were observed. Results There were 144 cases in group D and 143 cases in group M. Slow heart rate was the prominent manifestation in group D. The incidence of heart rate <50 beats per minute in group D (4.86%) was less than that in group M (6.29%), but there was no statistical difference ( P=0.681). Group D had lower blood pressure (40.28% vs. 72.73%), tachycardia (18.75% vs. 41.96%), arrhythmia (16.67% vs. 34.97%) and 28- day mortality (22.22% vs. 42.66%) than those in group M (P<0.01). No cardiac arrest, sinus arrest, hypertension, hyperglycemia, or hypoglycemia were found in the two groups. Conclusion The long-term sedation of dexmetidine in patients with mechanical ventilation is safe; in cardiovascular adverse events, the 28-day mortality is lower than that of traditional midazolam sedation, and the duration of mechanical ventilation is no longer than that of traditional midazolam sedation, with slightly longer ICU length of stay.

Citation： YANG Mingquan, LIU Yang, ZHOU Jie. Observation of cardiovascular adverse events of different sedatives in patients with mechanical ventilation in intensive care unit. West China Medical Journal, 2018, 33(8): 994-998. doi: 10.7507/1002-0179.201606168 Copy

1.	Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med, 2002, 30(1): 119-141.
2.	Ostermann ME, Keenan SP, Seiferling RA, et al. Sedation in the intensive care unit: a systematic review. JAMA, 2000, 283(11): 1451-1459.
3.	Jackson DL, Proudfoot CW, Cann KF, et al. A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety. Crit Care, 2010, 14(2): R59.
4.	Hoy SM, Keating GM. Dexmedetomidine: a review of its use for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation. Drugs, 2011, 71(11): 1481-1501.
5.	Christensen A. Update on dexmedetomidine for adult ICU sedation. Conn Med, 2009, 73(8): 469-472.
6.	Mantz J, Josserand J, Hamada S. Dexmedetomidine: new insights. Eur J Anaesthesiol, 2011, 28(1): 3-6.
7.	Wijeysundera DN, Bender JS, Beattie WS. Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery. Cochrane Database Syst Rev, 2009(4): CD004126.
8.	中華人民共和國國家衛生和計劃生育委員會. 重癥醫學專業醫療質量控制指標(2015 年版). (2015-04-13)[2016-01-03]. http://www.nhfpc.gov.cn/yzygj/s7657/201504/5fa7461c3d044cb6a93eb6cc6eece087.shtml.
9.	黃青青. 右美托咪定在重癥監護病房中的應用. 中國危重病急救醫學, 2010, 22(10): 578-580.
10.	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): 201-207.
11.	Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA, 2009, 301(5): 489-499.
12.	Ruokonen E, Parviainen I, Jakob SM, et al. Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation. Intensive Care Med, 2009, 35(2): 282-290.
13.	Gerlach AT, Murphy CV, Dasta JF. An updated focused review of dexmedetomidine in adults. Ann Pharmacother, 2009, 43(12): 2064-2074.
14.	Wunsch H, Kahn JM, Kramer AA, et al. Use of intravenous infusion sedation among mechanically ventilated patients in the United States. Crit Care Med, 2009, 37(12): 3031-3039.
15.	Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 2013, 41(1): 263-306.
16.	李雙玲, 王東信, 楊拔賢. 重癥加強治療病房成人患者淺鎮靜治療進展. 中華危重病急救醫學, 2016, 28(1): 89-93.
17.	Boyce K, Dillon EC, Perrott J, et al. Drug-Use evaluation comparing dexmedetomidine use at 3 health authority sites relative to manufacturer’s recommended directions (DECODE study). Can J Hosp Pharm, 2014, 67(5): 379-386.
18.	Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA, 2007, 298(22): 2644-2653.
19.	Lin YY, He B, Chen J, et al. Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? A meta-analysis. Crit Care, 2012, 16(5): R169.
20.	宋瑞霞, 李俊艷, 董晨明, 等. 右美托咪定在 ICU 機械通氣集束化治療中的臨床應用研究. 中華危重病急救醫學, 2015, 27(10): 836-840.
21.	鄭蓓蓓, 王迪芬, 付江泉. 右美托咪定與咪達唑侖在機械通氣重癥患者鎮靜治療中的比較研究. 中國中西醫結合急救雜志, 2015, 22(3): 307-311.
22.	Herr DL, Sum-Ping ST, England M. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens. J Cardiothorac Vasc Anesth, 2003, 17(5): 576-584.
23.	Afonso J, Reis F. Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anestesiol, 2012, 62(1): 118-133.
24.	Wunsch H, Kahn JM, Kramer AA, et al. Dexmedetomidine in the care of critically ill patients from 2001 to 2007: an observational cohort study. Anesthesiology, 2010, 113(2): 386-394.
25.	Yapici N, Coruh T, Kehlibar T, et al. Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state. Heart Surg Forum, 2011, 14(2): E93-E98.
26.	Shehabi Y, Bellomo R, Reade MC, et al. Early goal-directed sedation versus standard sedation in mechanically ventilated critically ill patients: a pilot study. Crit Care Med, 2013, 41(8): 1983-1991.
27.	Shehabi Y, Grant P, Wolfenden H, et al. Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology, 2009, 111(5): 1075-1084.
28.	翁云龍. 機械通氣患者過度鎮靜與臨床預后關系的回顧性隊列研究. 中國中西醫結合急救雜志, 2015, 22(5): 508-512.
29.	Shehabi Y, Bellomo R, Michael CR, et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill Patients. Am J respir Crit care Med, 2012, 86(8): 724-731.

1. Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med, 2002, 30(1): 119-141.
2. Ostermann ME, Keenan SP, Seiferling RA, et al. Sedation in the intensive care unit: a systematic review. JAMA, 2000, 283(11): 1451-1459.
3. Jackson DL, Proudfoot CW, Cann KF, et al. A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety. Crit Care, 2010, 14(2): R59.
4. Hoy SM, Keating GM. Dexmedetomidine: a review of its use for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation. Drugs, 2011, 71(11): 1481-1501.
5. Christensen A. Update on dexmedetomidine for adult ICU sedation. Conn Med, 2009, 73(8): 469-472.
6. Mantz J, Josserand J, Hamada S. Dexmedetomidine: new insights. Eur J Anaesthesiol, 2011, 28(1): 3-6.
7. Wijeysundera DN, Bender JS, Beattie WS. Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery. Cochrane Database Syst Rev, 2009(4): CD004126.
8. 中華人民共和國國家衛生和計劃生育委員會. 重癥醫學專業醫療質量控制指標(2015 年版). (2015-04-13)[2016-01-03]. http://www.nhfpc.gov.cn/yzygj/s7657/201504/5fa7461c3d044cb6a93eb6cc6eece087.shtml.
9. 黃青青. 右美托咪定在重癥監護病房中的應用. 中國危重病急救醫學, 2010, 22(10): 578-580.
10. 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): 201-207.
11. Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA, 2009, 301(5): 489-499.
12. Ruokonen E, Parviainen I, Jakob SM, et al. Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation. Intensive Care Med, 2009, 35(2): 282-290.
13. Gerlach AT, Murphy CV, Dasta JF. An updated focused review of dexmedetomidine in adults. Ann Pharmacother, 2009, 43(12): 2064-2074.
14. Wunsch H, Kahn JM, Kramer AA, et al. Use of intravenous infusion sedation among mechanically ventilated patients in the United States. Crit Care Med, 2009, 37(12): 3031-3039.
15. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 2013, 41(1): 263-306.
16. 李雙玲, 王東信, 楊拔賢. 重癥加強治療病房成人患者淺鎮靜治療進展. 中華危重病急救醫學, 2016, 28(1): 89-93.
17. Boyce K, Dillon EC, Perrott J, et al. Drug-Use evaluation comparing dexmedetomidine use at 3 health authority sites relative to manufacturer’s recommended directions (DECODE study). Can J Hosp Pharm, 2014, 67(5): 379-386.
18. Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA, 2007, 298(22): 2644-2653.
19. Lin YY, He B, Chen J, et al. Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients? A meta-analysis. Crit Care, 2012, 16(5): R169.
20. 宋瑞霞, 李俊艷, 董晨明, 等. 右美托咪定在 ICU 機械通氣集束化治療中的臨床應用研究. 中華危重病急救醫學, 2015, 27(10): 836-840.
21. 鄭蓓蓓, 王迪芬, 付江泉. 右美托咪定與咪達唑侖在機械通氣重癥患者鎮靜治療中的比較研究. 中國中西醫結合急救雜志, 2015, 22(3): 307-311.
22. Herr DL, Sum-Ping ST, England M. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens. J Cardiothorac Vasc Anesth, 2003, 17(5): 576-584.
23. Afonso J, Reis F. Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anestesiol, 2012, 62(1): 118-133.
24. Wunsch H, Kahn JM, Kramer AA, et al. Dexmedetomidine in the care of critically ill patients from 2001 to 2007: an observational cohort study. Anesthesiology, 2010, 113(2): 386-394.
25. Yapici N, Coruh T, Kehlibar T, et al. Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state. Heart Surg Forum, 2011, 14(2): E93-E98.
26. Shehabi Y, Bellomo R, Reade MC, et al. Early goal-directed sedation versus standard sedation in mechanically ventilated critically ill patients: a pilot study. Crit Care Med, 2013, 41(8): 1983-1991.
27. Shehabi Y, Grant P, Wolfenden H, et al. Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology, 2009, 111(5): 1075-1084.
28. 翁云龍. 機械通氣患者過度鎮靜與臨床預后關系的回顧性隊列研究. 中國中西醫結合急救雜志, 2015, 22(5): 508-512.
29. Shehabi Y, Bellomo R, Michael CR, et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill Patients. Am J respir Crit care Med, 2012, 86(8): 724-731.

West China Medical Journal

Observation of cardiovascular adverse events of different sedatives in patients with mechanical ventilation in intensive care unit

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