الفهرس 
Introduction
Principles of sedationOnly 14 pages are availabe for public view
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Abstract
The study was carried out from March 2015 to May 2016 on thirty poly traumatized adult patients (20-60 years) who admitted to ICU and in need for sedation and mechanical ventilation. Aim of work: The purpose of this study was to evaluate the effect of dexmedetomedine in ICU sedation in poly traumatized mechanically ventilated patients for more than 24h in direct comparison with propofol sedation. Patients were randomly allocated into two groups of equal size to receive either dexmedetomedine infusion (DEX group, n=15) or propofol infusion (Propofol group, n=15) for 72h. DEX Group: 0.2–0.7 mcg/kg/h dexmedetomedine for maintaining the sedation levels with Richmond Agitation- Sedation Scale RASS 0 down to RASS -3 Propofol Group: 10-70 mcg/kg/m propofol for maintaining the sedation levels with Richmond Agitation- Sedation Scale RASS 0 down to RASS -3. All patient were assessed for: • Patient’s demographic and clinical characteristics; Age, weight, sex, injury severity score and pathological diagnosis. • Efficacy evaluation parameters: RASS every2h until 36h and then every 12h till end of the study (72h), percentage of time within target sedation range, patient outcome at end of the study, total duration of mechanical ventilation and total ICU length of stay. • Safety evaluation parameters; Vital signs (HR, systolic BP, diastolic BP, mean BP, oxygen saturation, temperature, and urine output) every 2hour till 36 h and then every 12h till 72h), treatment-related adverse effects (e. g. bradycardia, hypotension and hypertension), withdrawal adverse effects (e.g tachycardia, hypertension, delirium and hallucination) and laboratory investigations (random blood sugar, blood picture, arterial blood gas, kidney and liver function before and at end of study drug infusion in the two studied groups). This study demonstrated that: - The patients’ demographic and clinical characteristics were similar in the two studied groups. - Significant differences between the two groups in the mean RASS were evident in the 4h (P<0.017), 8h (P<0.021), 30h (P<0.047), 36h (P<0.005), 48h (P<0.004), 60h (P<0.002) and 72 h (P<0.) - The percentage of time within the target sedation range (RASS score -3 to 0) during the treatment period was 94.4 % in the DEX group versus 88.8 % in the propofol group (p-value =0.916 ) without any significance . -Lower mean heart rates, systolic, diastolic and mean arterial pressure mean values were observed in DEX group compared with propofol group. -Patients in DEX group had lower mean urine output mean values compared with propofol group. - Five patients (33.3%) in the DEX group showed bradycardia and/or hypotension managed by interruption up to stoppage of the DEX infusion, atropine, iv fluid bolus, or use of vasopressor inotropes, accordingly. - Two patients in DEX group and 3 in propofol group were successfully weaned from mechanical ventilation with no difference between groups in the duration of mechanical ventilation or length of ICU stay. - Patients who successfully weaned from mechanical ventilation and patients who continued on mechanical ventilation and shifted to other sedatives after 72h, we did not report any rebound hypertension, tachycardia or other withdrawal adverse events. - The percentage of change in investigation between samples before sedation and samples after sedation in the two groups were as follow : • Hb decreased by 9.97 % in dexmedetomedine group while in propofol group ,Hb decreased by 7.62 % without any significance between the two groups . • Hb decreased by 9.97 % in dexmedetomedine group while in propofol group,Hb decreased by 7.62 % without any significance between the two groups. • Wbcs increased by 1.81 % in dexmedetomedine group while in propofol group , Wbcs decreased by 24.37 % with p-value < 0.045. • Platelet increased by 3.01 % in dexmedetomedine group while in propofol group , platelet increased by 26.32 with p-value < 0.032. • Random blood sugar decreased in dexmedetomedine group by 6.16 % while in propofol group RBS increased by 6.06 % but without any significance . • Serum urea decreased in dexmedetomedine while in propofol group serum urea increased but without any significance . • Serum creatinine decreased in dexmedetomedine while in propofol group there was slight increase in serum creatinine but without any significance. • Total bilirubin increased in dexmedetomedine group while in propofol group decreased but without any significance. • ALT increased in dexmedetomedine group while in propofol group decreased but without any significance. • AST decreased in the two groups without any significance.