The aim of this study is to assess the efficacy of dexmedetomidine as an adjunct to conventional sedative therapy (propofol) compared to conventional sedative therapy alone in patients with traumatic brain injury, as regards its effects on hemodynamics and intracranial pressure. The efficacy of dexmedetomidine for sedation in intubated ICU patients is well established however, its use in patients with traumatic brain injury (TBI) has not been comprehensively described. It suits as an ideal sedative agent for patients with TBI. It provides excellent sedation without respiratory depression, ease of arousability, and short-acting effects, has sympatholytic properties, and need not be stopped during weaning the patient from mechanical ventilation or for neurological assessment. The mechanism beyond the reduction of ICP in trauma patients may be due to arterial vasoconstriction induced by α2 agonist activity which in turn leads to a decrease in the cerebral blood volume. ĭexmedetomidine is a highly selective α2-adrenergic agonist that possesses sedative-, anxiolytic-, and analgesic-sparing properties. Several different classes of drugs are used as sedatives, but there is limited evidence available to guide the choice of specific sedative agents in TBI. Prevention and control of increased ICP and maintenance of cerebral perfusion pressure (CPP) are fundamental therapeutic goals after TBI. So, the primary aim of the intensive care management of TBI is to prevent and treat secondary ischemic injury. An increase in intracranial pressure (ICP) may impede cerebral blood flow (CBF) and lead to cerebral ischemia, and its degree and duration are associated with outcome after TBI. Cerebral edema and associated increased intracranial pressure are the major immediate consequences of TBI that contribute to most early deaths. TBI is a significant public health problem worldwide and is predicted to surpass many diseases as a major cause of death and disability. The incidence of complications does not vary greatly between all groups. Conclusionĭexmedetomidine or its combination with propofol is as effective as propofol alone in TBI all alternatives are equal as regards the degree of sedation, effect on intracranial pressure, and cerebral perfusion pressure. As regards hypotension, there was a statistically significant difference between the three studied groups. Tachycardia, bradycardia, and hypertension in the three groups were statistically insignificant. The number of ICP and CPP excursions per day was not significantly different between the three groups. ICP and CPP excursions and complications were assessed in the first 48 h. Patients were randomized into three equal groups: dexmedetomidine was infused in a dose of 0.5 μg/kg/h for 48 h in the first group, propofol 1% was infused in a dose of 4 mg/kg/h for 48 h in the second group, and dexmedetomidine was infused in a dose of 0.2 μg/kg/h and propofol was infused in a dose of 2 mg/kg/h for 48 h in the third group. Patients who required mechanical ventilation, Glasgow coma scale (GCS) < 8, or hemodynamically instable were excluded. This prospective randomized controlled clinical trial with 60 agitated and restless traumatic brain-injured patients was performed between May 2013 and May 2017. Cerebral edema and increased intracranial pressure are of the major consequences of traumatic brain injury that affects the outcome.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |