ABSTRACT
OBJECTIVE: to determine which drug dexmedetomidine or midazolam produces greater delirium in septic patients. METHODS: observational, analytical, comparative, prospective and longitudinal in 59 postsurgical patients both sexes, with mechanical ventilation (MV), sepsis, and sedation with dexmedetomidine or midazolam complicated with sepsis was done. We evaluated age, severity of sepsis with SOFA and APACHE. Complications associated with delirium were registered. The "t" Student test and χ(2) were used. RESULTS: Midazolam group, 33 patients, mean age 49.75 ± 19.48 years, SOFA 15.81 ± 7.48 points and APACHE 7.51 ± 5.41, delirium was present in 29 patients, days of MV 15.86 ± 14.12, reintubation rate 24 %, ICU stay 16.41 ± 14.41, hospital stay 28.58 ± 19.91 days and death rate 34.5 %. Dexmedetomidine group: 26 patients, mean age 49.57 ± 13.76 years, in SOFA 13.34 ± 7.66 points and 6.23 ± 4.51 in APACHE scale, delirium in 11 patients, days of MV 17.9 ± 12.53 and reintubation in 45.5 %, ICU days 14.36 ± 9.25, hospital stay 22.63 ± 14.87 and death in 36.4 %. CONCLUSIONS: delirium was increased in complicated post-surgical patients with sepsis, mechanical ventilation and midazolam.
Subject(s)
Delirium/chemically induced , Dexmedetomidine/adverse effects , Hypnotics and Sedatives/adverse effects , Midazolam/adverse effects , Postoperative Complications/chemically induced , Sepsis/complications , Female , Humans , Longitudinal Studies , Male , Middle Aged , Prospective StudiesABSTRACT
OBJECTIVE: To evaluate if type 2 diabetes mellitus (DM) constitutes a prognostic factor for death and severe disability in patients with aneurysm clipping after subarachnoid hemorrhage (ASH), in an Intensive Care Unit (ICU). MATERIAL AND METHODS: This is a cohort study in patients who were admitted to the ICU between December-2009 and June-2010; 20 with DM (exposed group) and 40 without DM (non-exposed group). Mortality was quantified during ICU stay. At ICU discharge, severe disability was measured through the Glasgow Outcome Scale (category 2); and Glasgow Coma Scale was used to estimate the difference in consciousness level between ICU arrival and discharge. Descriptive statistics and Kaplan Meier survival curves were performed. RESULTS: Mean age was similar between groups (55.8 +/- 11 and 55.6 +/- 15 years, respectively, p = 0.40). A vegetative state was present in one patient without DM. The Glasgow Coma Scale score at ICU entry was 14.1 +/- 1.4 and at discharge, 12.0 +/- 3.6 in the exposed group (p = 0.01); and 13.9 +/- 2.0 us. 13.5 +/- 2.6, in the non-exposed group, respectively (p = 0.45). There were 3 deaths in patients with DM and 5, in patients without DM (p > 0.05); survival time was 12 (95%CI 7, 16) and 10 days (95%CI 7, 13), respectively. Mean glucose remained higher in patients who died at the ICU (p < 0.001). Hydrocephaly was present in 6 exposed patients and 2, non-exposed (p = 0.007). Additionally, 7 and 5 with and without DM, respectively registered a positive blood culture (p = 0.04). CONCLUSIONS: DM was not associated with higher mortality in ICU patients, but hyperglycemia was; thus, it is essential that the intensive care provider watches closely the glycemic control.
