A comparison on sedative effects between dexmedetomidine and midazolam for severe patients undergoing mechanical ventilation in intensive care unit / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the sedative effects and analyze the cost-benefit of dexmedetomidine and midazolam for severe patients undergoing mechanical ventilation (MV) in intensive care unit (ICU). Methods A prospective randomized controlled trial was conducted. Eighty patients undergoing MV (24 hours 4, 0.5μg/kg fentanyl was added, when the analgesic goal was reached, the sedative treatment was given. In midazolam group, the patients received midazolam whose loading dose was 0.05 mg/kg intravenous injection (IV) in 2 minutes, followed by continuous IV pump infusion 0.03 - 0.30 mg·kg-1·h-1. In dexmedetomidine group, the patients received dexmedetomidine whose loading dose was slowly intravenous pump infusion of 0.5 - 1.0μg/kg, followed by continuous pump IV infusion of 0.2 - 0.7μg·kg-1·h-1; the sedation goal was richmond agitation-sedation scale (RASS) at 0 - 2, the score being taken once per hour, and as RASS > 0 point, the dosage of sedative was increased, and as RASS < -2, the dosage of sedative was reduced or discontinued. During the course of study, the heart rate (HR), blood pressure, the amount of sedative and analgesic used, duration of MV, extubation time, ICU stay time, total costs of sedative and fentanyl drugs, total ICU treatment costs and adverse reactions of patients were observed.Results Compared with midazolam group, the total amount of sedative used (mg/kg 0.03±0.01 vs. 3.35±1.39), the dose of sedative used per hour (μg·kg-1·h-1 0.66±0.13 vs. 59.78±19.44), the dose of fentanyl used (μg·kg-1·h-1 0.40±0.21 vs. 0.57±0.26), the total costs of fentanyl used per hour (yuan 1.41±0.86 vs. 2.00±0.84), the total costs in ICU per hour (yuan 264.42±99.55 vs. 297.80±138.70) in dexmedetomidine group were significantly less (allP < 0.05); compared with midazolam group, the total costs of sedative in dexmedetomidine group was significantly higher (yuan 8.97±5.05 vs. 7.78±4.22); the duration of MV [hours 43.58 (39.83, 53.58) vs. 58.58 (46.17, 65.50)], extubation time [hours 1.00 (1.67, 0.58) vs. 3.67 (2.00, 5.50)] and the time for staying in ICU [hours 57.25 (47.33, 67.37) vs. 75.58 (64.67, 90.83)] were significantly shorter in dexmedetomidine group (allP < 0.05); the incidences of adverse reactions in dexmedetomidine group were significantly higher [hypotension 29.27% (12/41) vs. 7.69% (3/39), bradycardia 24.39% (10/41) vs. 5.13% (2/39), bothP < 0.05]; the incidence of delirium in dexmedetomidine group was lower [2.43% (1/41) vs. 15.38% (6/39),P < 0.05].Conclusion For ICU patients, dexmedetomidine is an ideal effective sedative, as it may shorten the duration of MV, the time for extubation, the period staying in ICU, reduce the dosage of analgesic used and the cost of treatment in ICU.