Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial
Michael C Reade, Kim O'Sullivan, Samantha Bates, Donna Goldsmith, William RSTJ Ainslie and Rinaldo Bellomo
Critical Care 2009, 13:R75 (doi:10.1186/cc7890) Abstract
Introduction Agitated delirium is common in patients undergoing mechanical ventilation, and is often treated with haloperidol despite concerns about safety and efficacy. Use of conventional sedatives to control agitation can preclude extubation. Dexmedetomidine, a novel sedative and anxiolytic agent, may have particular utility in these patients. We sought to compare the efficacy of haloperidol and dexmedetomidine in facilitating extubation. Methods We conducted a randomised, open-label, parallel- groups pilot trial in the medical and surgical intensive care unit of a university hospital. Twenty patients undergoing mechanical ventilation in whom extubation was not possible solely because of agitated delirium were randomised to receive an infusion of either haloperidol 0.5 to 2 mg/hour or dexmedetomidine 0.2 to 0.7 μg/kg/hr, with or without loading doses of 2.5 mg haloperidol or 1 μg/kg dexmedetomidine, according to clinician preference.
Results Dexmedetomidine significantly shortened median time to extubation from 42.5 (IQR 23.2 to 117.8) to 19.9 (IQR 7.3 to 24) hours (P = 0.016). Dexmedetomidine significantly decreased ICU length of stay, from 6.5 (IQR 4 to 9) to 1.5 (IQR 1 to 3) days (P = 0.004) after study drug commencement. Of patients who required ongoing propofol sedation, the proportion of time propofol was required was halved in those who received dexmedetomidine (79.5% (95% CI 61.8 to 97.2%) vs. 41.2% (95% CI 0 to 88.1%) of the time intubated; P = 0.05). No patients were reintubated; three receiving haloperidol could not be successfully extubated and underwent tracheostomy. One patient prematurely discontinued haloperidol due to QTc interval prolongation. Conclusions In this preliminary pilot study, we found dexmedetomidine a promising agent for the treatment of ICU- associated delirious agitation, and we suggest this warrants further testing in a definitive double-blind multi-centre trial. 查看PDF全文 Dexmedetomidine and the Reduction of Postoperative Delirium after Cardiac Surger
José R Maldonado;Ashley Wysong; Pieter J A van der Starre; Thaddeus Block; C...
Psychosomatics;1ay/Jun 2009; 503; ProQuest Health and 1edical Complete pg.206 Background: Delirium is a neurobehal ra/ syndrome caused by the transient disruption of nor
ma/ neurona/ activity secondary ω systemic disturbances. Objective: 1 e authors investigated the fJects of postoperative sedation on the deve/opment of delirium in patients undergoing cardiac-va/ve procedures. Methods: Patients underwent e/ective cardiac surge.η with a standard- ized intraoperative anesthesia protoco/ followed by random assment ω one of three postoper ative sedation protoco/s: dexmedetomidinepropofo/or midazo/am. Results: The incidence of delirium for patients receiving dmedetomidine was 3% for those receiving propofo/ was 50% and for patients receiv gmidazo/am 50%. Patients who deve/oped postoperative delirium experienced signi.ficant/y /onger intensive-care stays and /onger ωω/ hospitalization. Conclusion: The findings of this open-/abe/randomized c/inica/ vesttiion suggest that postoperative se- dation with d medetomidine was associated with sign'cant/y /ower rates of postoperative delir ium and /ower care costs. 查看PDF全文 右美托咪定用于重症监护病房机械通气患者镇静效果观察
淡华臣
现代中西医结合杂志 Modern Journal of Integrated Traditional Chinese and Western Medicine 2012 Jul，21( 19)
［摘要］ 目的 观察右美托咪定和咪达唑仑对重症监护病房( ICU) 术后机械通气患者的镇静效果。方法 选择 术后带气管导管入 ICU 行呼吸机辅助通气患者 100 例，按随机数字表法分为 2 组，分别给予咪达唑仑( 48 例) 和右美 托咪定( 52 例) 镇静治疗，2 组均常规给予芬太尼持续静脉泵入镇痛。观察记录 2 组药物用量，停止右美托咪定或咪 达唑仑输注后至拔管所需时间，低血压、心动过缓、谵妄、恶心等不良反应发生率，右美托咪定组出现躁动( Riker 躁动 评分≥5 分) 者用药后 SAS 评分分值。结果 2 组镇静及镇痛效果无显著性差异。与咪达唑仑组比较，右美托咪定组 芬太尼用量明显减少，停药至拔管时间明显缩短，低血压和心动过缓发生率升高，谵妄发生率明显降低。右美托咪定 组中躁动患者 SAS 评分均较用药前下降。结论 右美托咪定用于外科术后机械通气患者镇静效果满意，易唤醒，谵 妄发生率低，可缩短拔管时间，减少芬太尼用量约 50% ，是一种较为理想的 ICU 镇静剂，但要加强用药期间的监测，防 治低血压和心动过缓。
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右美托嘧啶预防谵妄的研究进展及机制
姚月勤
药物与临床2009年12月第16卷第24期
[摘要]临床上高达35%～80%的重症住院患者发生谵妄。谵妄可使重症患者的发病率和病死率增加。右旋美托嘧啶是一种较新型的重症监护病房镇静药，具有镇静和镇痛作用特性。本文综述了谵妄的原因以及右美托嘧啶对谵妄的防治和机制。
[关键词]谵妄；右美托嘧啶；ICU
查看PDF全文 谵妄在综合医院住院患者中的临床特点分析
姜荣环*刘朝忠*周沫*吕秋云*
中国神经精神疾病杂志2009年第35卷第2期 【摘要】目的了解谵妄在综合医院住院患者中的临床特点。方法对1年内综合医院住院患者中精神科联络会诊明确诊断为谵妄的93例患者的临床特点进行分析,并与336例会诊后明确为非谵妄患者进行比较。结果谵妄患者的平均年龄高于非谵妄患者[(71+15)岁vs(59+18)岁,P<0.05]。会诊时精神障碍的病程短于1周的比例,谵妄组高于非谵妄组(56.0%vs18.3%,P<
0.05)。谵妄组来自重症监护病房(10.8%)和外科者(36.4%)高于非谵妄组(4.2%和21.4%),而来自内科较少(56.5%vs
36.6%),上述差异均有统计学意义(P<0.05)。谵妄组以精神病性发作(61.8%)和认知障碍(20.2%)作为会诊原因的比例高于非谵妄组(18.5%和1.0%),差异有统计学意义(P<0.05)。谵妄组罹患创伤或手术、呼吸系统疾病和多系统疾病(26.7%、10.5%、20.9%)者高于非谵妄组(15.9%、4.7%、10.9%),而循环系统疾病较少(3.5%vs16.5%),差异均有统计学意义(P<0.05)。高龄(>65岁)、被非精神科医生识别为精神病性发作和认知障碍、精神科会诊时刻较早、罹患创伤或者手术、呼吸系统疾病和多系统疾病、在重症监护病房治疗与谵妄密切相关(P<0.05)。80.6%的患者应用了药物治疗,常用的药物为氟哌啶醇、奥氮平、喹硫平和利培酮。结论对于在外科和重症监护病房治疗的创伤、呼吸系统疾病、多系统疾病或术后的老年患者应高度注意发生谵妄的可能性。
【关键词】联络会诊 精神病学 谵妄 综合医院 住院患者
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