Dexmedetomidine infusion for more than 24 hours in critically ill patients sedative and cardiovascul.pdf

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Dexmedetomidine infusion for more than 24 hours in critically ill patients sedative and cardiovascul.pdf

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Dexmedetomidine infusion for more than 24 hours in critically ill patients sedative and cardiovascul

Intensive Care Med (2004) 30:2188–2196 DOI 10.1007/s00134-004-2417-z O R I G I NA L Yahya Shehabi Urban Ruettimann Harriet Adamson Richard Innes Mathieu Ickeringill Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects Received: 25 July 2003 Accepted: 26 July 2004 Published online: 26 August 2004 Springer-Verlag 2004 The study was performed in the Intensive Care Units of the Prince of Wales hospital, a principal teaching hospital of the Uni- versity of New South Wales and the Prince of Wales private hospital. Abbott Australia provided the study drug free of charge Y. Shehabi ()) · U. Ruettimann · H. Adamson · R. Innes · M. Ickeringill Prince of Wales Hospital, Barker Street, Randwick 2031, NSW, Australia e-mail: yshehabi@.au Fax: +61-2Abstract Objective: To assess the potential of dexmedetomidine for targeted sedation in complex Inten- sive Care (ICU) patients for 24 h. Design: Prospective, open label, clinical trial. Setting: Tertiary general ICU. Patients: Twenty critically ill patients, mean APACHE II 23(€9). Interventions: A continuous infusion of dexmedetomidine, median infu- sion time 71.5 (35–168) h, starting at 0.4mg·kg·h without a loading dose and adjusted (0.2–0.7mg·kg·h) to a target Ramsay Sedation Score (RSS) of 2–4. Rescue midazolam and/or morphine/fentanyl were given as clinically indicated. Measurements and results: Haemodynamic parame- ters and RSSs were collected until 24 h after cessation. An RSS 2–5 was achieved in 1,147 (83%) of observa- tions with a reduction in RSS of 6 from 13% in the first 6 h to 3% be- tween 18 h and 24 h. Sixteen patients needed minimal or no additional mi- dazolam, median 4 mg/day (0.5–10) and ten required minimal or no ad- ditional analgesia, median 2 mg/day (0.5–4.5), 55mg/day (14–63) of mor- phine/fentanyl. Results: A 16% re- duction in mean systolic blood pres- sure (SBP) and 21% reduction in heart rate (HR) occurred over the first 4 h followed by mi