medigraphic.com

2012, Number 4

<< Back Next >>

Rev Med Inst Mex Seguro Soc 2012; 50 (4)

Postsurgical delirium complicated with sepsis. Dexmedetomidine adversus midazolam

Pérez-Rada FJM, Macías-García MT, Cataneo-Cerna AC

Language: Spanish
References: 37
Page: 419-426
PDF size: 51.39 Kb.


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 χ2 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.



REFERENCES

  1. Gunther ML, Morandi A, Ely EW. Pathophysiology of delirium in the intensive care unit. Crit Care Clin 2008;24(1):45-65.

  2. Maldonado JR. Delirium in the acute care setting: characteristics, diagnosis and treatment. Crit Care Clin 2008;24 (4):657-722.

  3. Skrobik Y. Delirium prevention and treatment. Crit Care Clin 2009;25(3):585-591.

  4. Jackson JC, Mitchell N, Hopkins RO. Cognitive functioning, mental health, and quality of life in ICU survivors: an overview. Crit Care Clin 2009;25(3):615-628.

  5. Attard A, Ranjith G, Taylor D. Delirium and its treatment. CNS Drugs 2008;22(8):631-644.

  6. Michaud L, Büla C, Berney A, Camus V, Voellinger R, Stiefel F. Delirium: guidelines for general hospitals. J Psychosomatic Res 2007;62(3):371-383.

  7. Maldonado JR. Pathoetiological model of delirium: a comprehensive understanding of the neurobiology of delirium and an evidence-based approach to prevention and treatment. Crit Care Clin 2008;24(4):789-856.

  8. Pun BT, Ely EW. The importance of diagnosing and managing ICU delirium. Chest 2007;132(2):624-636.

  9. Aldemir M, Ozen S, Kara IH, Sir A, Baç B. Predisposing factors for delirium in the surgical intensive care unit. Crit Care 2001;5 (5):265-271. Disponible en http://www.ncbi. nlm.nih.gov/pmc/articles/PMC83853/?tool=pubmed

  10. Bagri AS, Rico A, Ruiz JG.. Evaluation and management of the elderly patient at risk for postoperative delirium. Clin Geriatric Med 2008;24(4):667-686.

  11. Pustavoitau A, Stevens RD. Mechanism of neurologic failure in critical illness. Crit Care Clin 2008;24(1):1-24.

  12. Girard T, Pandharipande P, Ely E. Delirium in the intensive care unit. Crit Care 2008;12(Supl 3):S3. Disponible en http://ccforum.com/content/12/S3/S3

  13. McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK, et al. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 2003; 51(5):591-598.

  14. Sieber SE. Postoperative delirium in the elderly surgical patient. Anesthesiol Clin 2009;27(3):451-464.

  15. Inouye SK. Delirium in older persons. N Engl J Med 2006; 354(11):1157-1165.

  16. Lee HB, DeLoatch CJ, Cho S, Rosenberg P, Mears SC, Sieber FE. Detection and management of pre-existing cognitive impairment and associated behavioral symptoms in the Intensive Care Unit. Crit Care Clin 2008;24(4):723-736. Disponible en http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2610456/?tool=pubmed

  17. Stevens RD, Nyquist PA. Coma, delirium, and cognitive dysfunction in critical illness. Crit Care Clin 2007;22(4):787-804.

  18. Jackson JC, Mitchell N, Hopkins RO. Cognitive functioning, mental health, and quality of life in ICU survivors: an overview. Crit Care Clin 2009;25(3):615-628.

  19. Riker RR, Fraser GL. Altering intensive care sedation paradigms to improve patient outcomes. Crit Care Clin 2009;25 (3):527-538.

  20. Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, et al. Efficacy and safety of paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial). A randomized controlled trial. Lancet 2008;371 (9607):126-134.

  21. Pisani MA, Araujo KL, van Ness PH, Zhang Y, Ely EW, Inouye SK. A research algorithm to improve detection of delirium in the intensive care unit. Crit Care 2006;10(4): R121. Disponible en http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC1750978/?tool=pubmed

  22. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critical ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 2001;29(7):1370-1379.

  23. Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, et al. Effect of sedation with dexmedetomidine vs. lorazepam on acute brain disfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 2007;298(22):2644-2653.

  24. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 2001;29: 1370-1379.

  25. Gunther ML, Jackson JC, Ely EW. The cognitive consequences of critical illness: practical recommendations for screening and assessment. Crit Care Clin 2007;23(3):491- 506.

  26. Pandharipande P, Ely EW. Sedative and analgesic medications: risk factors for delirium and sleep disturbances in the critically ill. Crit Care Clin 2006;22(2):313-327.

  27. Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ. Sedation in the intensive care unit: a systematic review. JAMA 2000;283(11):1451-1459.

  28. Ebersoldt M, Sharshar T, Annane D. Sepsis associated delirium. Intensive Care Med 2007;33(6):941-950.

  29. Pfister D, Siegemund M, Dell-Kuster S, Smielewski P, Rüegg S, Strebel SP. Cerebral perfusion in sepsis associated delirium. Crit Care 2008;12(3):1-9. Disponible en http://www. ncbi.nlm.nih.gov/pmc/articles/PMC2481444/?tool=pubmed

  30. Pandharipande P, Cotton BA, Shintani A, Thompson J, Costabile S, Truman Pun B, et al. Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med 2007;33(10):1726-1731.

  31. Devlin JW, Fong JJ, Fraser GL, Riker RR. Delirium assessment in the critically ill. Intensive Care Med 2007;33(6):929- 940.

  32. Plaschke K, von Haken R, Scholz M, Engelhardt R, Brobeil A, Martin E, et al. Comparison of the confusion assessment method for the intensive care unit (CAM-ICU) whit the Intensive Care Delirium Screening Checklist (ICDS) for delirium in critical care patients gives high agreement rate(s). Intensive Care Med 2008;34(3):431-436.

  33. Weinhouse GL, Watson PL. Sedation and sleep disturbances in the ICU. Crit Care Clin 2009;25(3):539-549.

  34. Salas RE, Gamaldo CE. Adverse effects of sleep deprivation in the ICU. Crit Care Clin 2008;24(3):461-476.

  35. Devlin JW, Roberts RJ. Pharmacology of commonly used analgesics an sedatives in the ICU: benzodiazepines, propofol and opioids. Crit Care Clin 2009;25(3):431-449.

  36. Siami S, Annane D, Sharshar T. The encephalopathy in sepsis. Crit Care Clin 2008;24(1):67-82.

  37. Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 2009; 301(5):489-499.




2020     |     www.medigraphic.com